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Chen et al. Hepatoma Res 2018;4:72 Hepatoma Research
DOI: 10.20517/2394-5079.2018.103

Original Article Open Access

Surveillance for hepatocellular carcinoma - current
status and advances

1,2
1
Kaina Chen , Pik-Eu Chang , George Boon-Bee Goh , Chee-Kiat Tan 1,2
1,2
1 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore.
2 Department of Medicine, Duke-NUS Medical School, Singapore 169857, Singapore.
Correspondence to: Dr. Chee-Kiat Tan, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
169608, Singapore. E-mail: tan.chee.kiat@singhealth.com.sg
How to cite this article: Chen K, Chang PE, Goh GBB, Tan CK. Surveillance for hepatocellular carcinoma - current status and advances.
Hepatoma Res 2018;4:72. http://dx.doi.org/10.20517/2394-5079.2018.103
Received: 5 Oct 2018 First Decision: 24 Oct 2018 Revised: 2 Nov 2018 Accepted: 6 Nov 2018 Published: 12 Dec 2018

Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Huang-Liang Wu

Abstract
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
and convenient.

Conclusion: The current evidence supports HCC surveillance as it detects earlier stage of tumor, allows more
curative treatment and improves survival. Further research on hepatocarcinogenesis and novel surveillance
modalities will continue to refine surveillance guidelines to reduce HCC-related mortality.

Keywords: Hepatocellular carcinoma, surveillance, surveillance modalities, screening, biomarkers

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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