title: Surveillance for hepatocellular carcinoma in chronic liver disease: evidence and controversies.
abstract: Primary liver cancer is the sixth most common cancer in the world and the third cause of cancer-related death. Hepatocellular carcinoma (HCC) represents more than 90% of primary liver cancers and generally occurs in patients with underlying chronic liver disease such as viral hepatitis, hemochromatosis, primary biliary cirrhosis and non-alcoholic steatohepatitis. Especially cirrhotic patients are at risk of HCC and regular surveillance could enable early detection and therapy, with potentially improved outcome. We here summarize existing evidence for surveillance including ultrasound, other radiological modalities and various serum biomarkers, and current international guideline recommendations for surveillance. Ultrasound and α-fetoprotein (alone or in combination) are most frequently used for surveillance, but their sensitivities and specificities are still far from perfect, and evidence for surveillance remains weak and controversial. Various other potential surveillance tools have been tested, including serum markers as des-carboxyprothrombin, lectin-bound α-fetoprotein, and (most recently) circulating TIE2-expressing monocytes, and radiological investigations such as computed tomography-scan or magnetic resonance imaging-scan. Although early results appear promising, these tools have generally been tested in diagnostic rather than surveillance setting, and in most cases, no detailed information is available on their cost-effectiveness. For the near future, it remains important to define those patients with highest risk of HCC and most benefit from surveillance, and to restrict surveillance to these categories.
authors.affiliation: Suzanne van Meer, Peter D Siersema, Karel J van Erpecum, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: van Meer
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002908:Chronic Disease; D003952:Diagnostic Imaging / Q000379:methods; D018450:Disease Progression; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor
keywords: Chronic liver disease; Hepatocellular carcinoma; Surveillance