Surveillance and diagnosis of hepatocellular carcinoma: A systematic review

Abstract

BACKGROUND Hepatocellular carcinoma (HCC) appears in most of cases in patients with advanced liver disease and is currently the primary cause of death in this population. Surveillance of HCC has been proposed and recommended in clinical guidelines to obtain earlier diagnosis, but it is still controversial and is not accepted worldwide. AIM To review the actual evidence to support the surveillance programs in patients with cirrhosis as well as the diagnosis procedure. METHODS Systematic review of recent literature of surveillance (tools, interval, cost-benefit, target population) and the role of imaging diagnosis (radiological non-invasive diagnosis, optimal modality and agents) of HCC. RESULTS The benefits of surveillance of HCC, mainly with ultrasonography, have been assessed in several prospective and retrospective analysis, although the percentage of patients diagnosed in surveillance programs is still low. Surveillance of HCC permits diagnosis in early stages allows better access to curative treatment and increases life expectancy in patients with cirrhosis. HCC is a tumor with special radiological characteristics in computed tomography and magnetic resonance imaging, which allows highly accurate diagnosis without routine biopsy confirmation. The actual recommendation is to perform biopsy only in indeterminate nodules. CONCLUSION The evidence supports the recommendation of performing surveillance of HCC in patients with cirrhosis susceptible of treatment, using ultrasonography every 6 mo. The diagnosis evaluation of HCC can be established based on noninvasive imaging criteria in patients with cirrhosis.

Galectin-3 is not useful for hepatocellular carcinoma surveillance in cirrhotic patients but it may be a marker of cirrhosis development

“…Serum AFP is the traditional tumor marker used for HCC diagnosis [5,17]. However, serum AFP levels are normal in up to 30% of HCC patients, particularly in the early stage of the disease [18].…”

The Cancer Genome Atlas (TCGA) based m 6 A methylation-related genes predict prognosis in hepatocellular carcinoma

“…In the past few decades, HCC has become the fifth most common cancer with a second highest mortality rate and a poor survival outcome worldwide [ 1 ]. Several risk factors have been linked to HCC [ 2 ]; however, its prognostic predictions are yet to be fully elucidated.…”

Liver and COVID-19: From care of patients with liver diseases to liver injury

“…HCC is the sixth most commonly diagnosed and the fourth leading cause of cancer-related death in the world, being one of the major health challenges in liver clinic[ 65 , 66 ]. There is scarce information on the impact of COVID-19 in patients with HCC - in a small study, Zhang et al [ 67 ] reported poorer outcomes in patients with HCC but also with other malignancies when compared to the general population.…”