Recurrent relapse after late relapse

Patients after successful treatment of a late recurrence are at risk of both early and late repeated relapse. In the Indiana University series, 44% of patients with a first relapse had a second one after achieving a NED state [17]. A durable response was achieved in only 30% of patients, mainly by surgery. In almost 20% of cases, the second relapse occurred more than 2 years after complete response of the first late relapse [6]. Elevated AFP levels at first relapse may be associated with a higher risk of second late relapse [6]. The outcome of patients with recurrent relapses is poor.

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