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Liu et al. Hepatoma Res 2020;6:42 I http://dx.doi.org/10.20517/2394-5079.2020.25 Page 7 of 12

Figure 1. Potential clinical applications of genetic-based tests in alcoholic cirrhosis and related hepatocellular carcinoma. *It would be
unethical to use genetic tests in the pre-transplant setting to determine if a patient should be offered liver transplantation. AFP: alpha-
fetoprotein; CT: computed tomography; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging

chronic hepatitis B and hepatitis C infection [83,84] . It is likely that the combination of several genetic variants
(rather than any single SNP) with or without clinical variables into a score will be most predictive. Since
[85]
the surveillance interval of 6 months for patients was determined on the basis of estimated tumor
doubling time (rather than tumor development risk), shortening intervals (e.g., to every 3 months) for ALD
[86]
patients classified as high-risk may not result in improved outcomes . However, risk calculators may help
identify high-risk patients without cirrhosis, who should undergo surveillance (akin to surveillance of non-
cirrhotic chronic hepatitis B patients) or those who should be surveyed with a more sensitive modality (e.g.,
computed tomography scan or magnetic resonance imaging). Conversely, risk scores may select out a low-
risk group of patients with ALD who can safely forego surveillance, especially in resource-poor settings
[Figure 1]. The development and application of risk scores using genetics needs to be explored further.

Given the rise of alcohol-related HCC in the post-HCV era, it is imperative that more research be
conducted in this area, providing a deeper understanding of the underlying risks and early diagnosis of
HCC in patients with ALD. Possibilities exist of repurposing biomarkers and therapeutic agents for alcohol-
related HCC identified/used for other etiologies.