Hepatocellular Carcinoma Screening and Surveillance

Abstract

Hepatocellular carcinoma (HCC) is the seventh most common malignancy worldwide. HCC meets all the criteria established by the World Health Organization for performing surveillance on those at-risk for developing cancer. Although there are consensus guidelines in the United States, Europe, and Asia for HCC surveillance, it is unclear if these guidelines are regularly implemented in routine practice to optimize real-life clinical outcomes. We reviewed the current literature on the adherence to current HCC practice guidelines by the American Association for the Study of Liver Diseases (2009), the European Association for the Study of the Liver (2012), and the Asia Pacific Association for the Study of the Liver (2010) for screening/surveillance and outcomes of optimal versus poor adherence. We performed PubMed search for relevant articles regarding HCC surveillance and screening worldwide. Currently, HCC screening is underutilized to a large extent. In most studies, the adherence to HCC screening and surveillance is suboptimal. Various patient, provider, and health care system factors may have all contributed to such nonadherence. Strategies to improve HCC screening and surveillance are urgently needed for early HCC detection and improved survival of HCC patients. Further research is needed to elucidate the various medical and/or cultural knowledge, belief, and practice patterns that can lead to barriers to HCC screening and surveillance at both patient and provider levels. These data will help focus and target advocacy and educational efforts to improve HCC surveillance at all levels: patients, providers, and health care system/government.

Poor adherence to hepatocellular carcinoma surveillance: A systematic review and meta‐analysis of a complex issue

“…Similarly, no specific aetiologies for cirrhosis were offered by some studies so there were insufficient details to examine adherence to HCC surveillance patients with cirrhosis of different aetiologies. There were also only one study from Asia and none from Africa, which by itself is very notable because East Asia and Sub‐Saharan Africa are two of the regions with the highest HCC disease burden in the world . Though publication bias is not a required element when there is not a comparison group in the analyses, to strengthen our study results we reviewed meeting abstracts of several international liver meetings over the past 4 years.…”

“…Although imaging with AFP had a higher surveillance rate than imaging only,we feel this may be a spurious result caused by very stringent and complicated surveillance protocols instituted separately from the accepted guidelines. An excellent example is found when reviewing the very high adherence rate in data from Japan; however, the Japanese HCC surveillance protocol is very rigorous and complicated …”

Screening and management of viral hepatitis and hepatocellular carcinoma in Mongolia: results from a survey of Mongolian physicians from all major provinces of Mongolia

“…For example, although there are consensus guidelines in the USA, Europe and Asia for HCC surveillance, the adherence to HCC screening and surveillance is suboptimal. [24][25][26] These applications would allow clinical guidelines to be disseminated directly to the patient with features such as reminders to encourage better adherence. The patients are then empowered to change the course of their own disease management.…”

Dose and Location of Irradiation Determine Survival for Patients with Hepatocellular Carcinoma with Macrovascular Invasion in External Beam Radiation Therapy

“…The prognosis with respect to OS of advanced HCC with MVI or extrahepatic metastasis is generally reported as 3–6 months [22]. Sorafenib is described as the first recommended treatment for these advanced HCC patients in the established therapeutic guidelines [23, 24]. This recommendation is principally based on the results of two large-scale, randomized, double-blind, phase 3 clinical trials, i.e.…”