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Chen et al. Hepatoma Res 2018;4:72 I http://dx.doi.org/10.20517/2394-5079.2018.103 Page 13 of 16

In conclusion, studies have shown that current surveillance strategies can detect significantly more early
stage HCCs: 61.3%-88% were within Milan criteria and 61%-91.7% were BCLC stage 0/A compared to 11.6%-
44% and 21%-73.3% respectively for subjects who were not on HCC surveillance [14,60-62] . Up to 73.8%-80% of
the HCC patients in the surveillance group received curative management with a median survival as high
as 4.7 years and a 3-year survival of up to 73% compared to only 45% of subjects not on surveillance being
amenable to curative therapy with a median survival of only up to 2.6 years [20,61,63] . Hence, HCC surveillance
in at-risk patients is beneficial and improves patient outcome.

Further research on hepatocarcinogenesis and novel surveillance tools will continue to help refine the
surveillance guidelines. In particular, further understanding of the hepatocarcinogenesis pathway in non-
alcoholic fatty liver disease-related HCC is needed to evolve a surveillance strategy for this huge group of pa-
tients. The aim is always to detect more curable HCC in patients with chronic liver disease and hence reduce
HCC-related mortality in the near future.

DECLARATIONS
Acknowledgements
We like to thank and acknowledgement our colleague Dr. Yu-Tien Wang for his insightful comments on the
article.

Author’s contributions
Design of the work: Chen K, Tan CK
Acquisition, analysis of data: Chen K
First draft of the manuscript: Chen K
Writing and editing of the manuscript: Chen K, Chang PE, Goh GBB, Tan CK

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Zhu RX, Seto WK, Lai CL, Yuen MF. Epidemiology of hepatocellular carcinoma in the Asia-Pacific region. Gut Liver 2016;10:332-9.
2. Schmidt S, Follmann M, Malek N, Manns MP, Greten TF. Critical appraisal of clinical practice guidelines for diagnosis and treatment of
hepatocellular carcinoma. J Gastroenterol Hepatol 2011;26:1779-86.
3. International Agency for Research on Cancer. GLOBOCAN 2012. Available from: http://globocan.iarc.fr/Default.aspx. [Last accessed on 9
Nov 2018]
4. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, et al. Liver transplantation for the treatment of small hepatocellular carcinomas
in patients with cirrhosis. N Engl J Med 1996;334:693-700.
5. Goh GBB, Chang PE, Tan CK. Changing epidemiology of hepatocellular carcinoma in Asia. Best Pract Res Clin Gastroenterol
2015;29:919-28.
6. Goh GBB, Li JW, Chang PE, Chow KY, Tan CK. Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: a