Surveillance for hepatocellular carcinoma: current status and future perspectives for improvement

Abstract

Introduction Hepatocellular carcinoma (HCC) is a globally-relevant medical problem. Fortunately, risk factors for this tumor have been identified, and surveillance protocols developed. Patients with liver cirrhosis have the highest risk of developing HCC and have historically been included in surveillance programs. Special categories have also emerged in recent years, especially patients with eradicated HCV infection or nonalcoholic fatty liver disease. Novel serum biomarkers and magnetic resonance imaging protocols are currently being proposed to refine existing surveillance protocols. Areas covered We discuss the rationale of surveillance programs for HCC and report the most recent recommendations from international guidelines about this topic. Grey areas, such as nonalcoholic fatty liver disease and the role of intrahepatic cholangiocellular carcinoma, are also discussed. Expert opinion Surveillance is recognised as a tool to favor early diagnosis of HCC, access to curative treatment and increase survival, even if the supporting evidence is mainly based on observational studies. As new randomised clinical trials are difficult to propose, future challenges will include optimising implementation in the primary care setting and a more personalised approach, balancing the opportunities and risks of overdiagnosis of novel techniques and biomarkers. Plain Language Summary Not long after its development, ultrasound (US) has been used to identify liver cancer in patients with liver cirrhosis. Consequently, US-based semiannual surveillance programs have been implemented in recent decades to facilitate an early diagnosis of liver cancer and increase chances of successful radical treatment. The efficacy of these protocols has been recognised in observational studies and clinical trials. However, recent years have shown the appearance of new categories of patients with chronic liver disease. Also, imaging innovations and putative novel biomarkers appeared on the stage. This review discusses the current knowledge and future perspective of these surveillance programs for liver cancer.