Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?
Purpose of Review
Current clinical practice guidelines recommend regular hepatocellular carcinoma (HCC) surveillance with biannual ultrasound with or without serum alpha-fetoprotein uniformly applied to all patients with cirrhosis. However, clinical implementation of this one-size-fits-all strategy has been challenging as evidenced by very low application rate below 20% due to various reasons, including suboptimal performance of the surveillance modalities.
Newly emerging imaging techniques such as abbreviated MRI (AMRI) and molecular HCC risk biomarkers have increasingly become available for clinical evaluation and implementation. These technologies may have a potential to reshape HCC surveillance by enabling tailored strategies. This would involve performing optimized surveillance tests according to individual HCC risk and allocating limited medical resources for HCC surveillance based on cost-effectiveness.
Tailored HCC surveillance could lead to achievement of precision HCC care and substantial improvement of the current dismal patient prognosis.
KeywordsHepatocellular carcinoma Surveillance Precision medicine Molecular risk stratification
Alcoholic liver disease
Hepatitis B virus
Hepatitis C virus
Magnetic resonance imaging
Non-alcoholic fatty liver disease
Single nucleotide polymorphism
This work was supported by the FLAGS foundation, the Nuovo-Soldati Cancer Research Foundation, and a research fellowship by the Geneva University Hospital to NG and NIH/NIDDK R01 DK099558, Irma T. Hirschl Trust, Dr. Harold and Golden Lamport Research Award, European Union ERC-2014-AdG-671231-HEPCIR, and US Department of Defense W81XWH-16-1-0363 to YH.
Compliance with Ethical Standards
Conflict of Interest
Nicolas Goossens, C. Billie Bian, and Yujin Hoshida each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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