Abstract
Hepatocellular carcinoma (HCC) incidence has dramatically decreased in patients infected with HCV and HBV due to the widespread use of highly effective antiviral agents. Nevertheless, a substantial proportion of patients with advanced fibrosis or cirrhosis following HCV clearance of in case of HBV control whatever the stage of fibrosis remains at risk of liver cancer development. Cancer predictors in these virus-free patients include routine parameters estimating coexisting comorbidities, persisting liver inflammation or function impairment, and results of non-invasive tests which can be easily combined into HCC risk scoring systems. The latter enables stratification according to various liver cancer incidences and allocation of patients into low, intermediate or high HCC risk probability groups. All international guidelines endorse lifelong surveillance of these patients using semi-annual ultrasound, with known sensibility issues. Refining HCC prediction in this growing population ultimately will trigger personalized management using more effective surveillance tools such as contrast-enhanced imaging techniques or circulating biomarkers while taking into account cost-effectiveness parameters.
Highlights
The main goal of anti-hepatitis B virus (HBV) therapy using nucleos(t)ide analogues (NUCs) in patients with chronic active hepatitis B is limiting the progression of liver disease through long-term suppression of HBV viral load, a circumstance during which numerous studies have reported a reduction in hepatocellular carcinoma (HCC) incidence [2]
In the vast majority of patients with hepatitis C virus (HCV) infection, including those with extensive fibrosis or cirrhosis, direct-acting antivirals (DAAs) are associated with a sustained virological response (SVR) [3]; HCC incidence in individuals infected with HCV with extensive fibrosis or cirrhosis is decreased following viral eradication
Following SVR, the risk of HCC is highest in patients with cirrhosis and is considered negligible in patients with mild or no fibrosis; HCC surveillance is not recommended for the latter group [4]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. New serum biomarkers that may improve sensitivity for early HCC detection have been a focus of interest in numerous studies but are still under exploration [9] Implementing these new tools into surveillance programmes may not be cost-effective for all patients, for those who have achieved HCV clearance or HBV control, in whom decreased annual HCC incidences are well established [10]. The use of an expensive but highly sensitive imaging technique such as MRI, which is able to detect small liver lesions, could be justified in populations with the highest risk of liver cancer [13] despite viral clearance or control, as reported by cost-effectiveness analyses performed in Asian patients infected with HBV with an annual HCC incidence above 3% [14]. The optimal thresholds will depend upon the proportion of patients allocated to each and onExtensive cost-effectiveness
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