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Surveillance for hepatocellular carcinoma - current status and advances

Aim: Hepatocellular carcinoma (HCC) is a common cancer worldwide, especially in Asia, with high mortality. Curative options are only available for early-stage HCC, which are usually asymptomatic and best diagnosed through surveillance. Risk factors associated with HCC include liver cirrhosis due to alcohol, chronic viral hepatitis infections and nonalcoholic steatohepatitis. We review the evidence supporting the benefits and drawbacks of HCC surveillance as well as new surveillance modalities. Methods: A MEDLINE and Cochrane Database search with defined search phrases was performed. Studies published from Jan 2000 to Jul 2018 were reviewed and publications focusing on the benefits and harms of HCC surveillance were qualitatively synthesized. Modalities of HCC surveillance were also reviewed. Results: A total of 5 randomized controlled trials (RCTs) and 24 cohort studies with sample size of more than 100 each were selected. Significant mortality reduction was demonstrated in 1 RCT. Cohort studies showed overall improved outcomes in the surveillance group with 61.3%-88% of HCC being detected in an early-stage and with up to 80% eligible for curative treatments. A quarter (27.5%) of the surveillance patients experienced additional scans or procedures due to false-positive results. Combination of ultrasound with alpha-fetoprotein increases HCC detection rate. Novel serum markers and liquid biopsy are attractive tools for surveillance as they are non-invasive