Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2021; 27(33): 5536-5554
Published online Sep 7, 2021. doi: 10.3748/wjg.v27.i33.5536
Surveillance for hepatocellular carcinoma in chronic viral hepatitis: Is it time to personalize it?
Coskun Ozer Demirtas, Maurizia Rossana Brunetto
Coskun Ozer Demirtas, Department of Gastroenterology and Hepatology, Marmara University, School of Medicine, Istanbul 34854, Turkey
Maurizia Rossana Brunetto, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56125, Italy
Maurizia Rossana Brunetto, Hepatology Unit, University Hospital of Pisa, Pisa 56125, Italy
Maurizia Rossana Brunetto, Biostructure and Bio-imaging Institute, National Research Council of Italy, Naples 56125, Italy
Author contributions: Demirtas CO performed the literature search and wrote the paper; Brunetto MR critically revised the manuscript; All authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Coskun Ozer Demirtas, MD, Postdoctoral Fellow, Department of Gastroenterology and Hepatology, Marmara University, School of Medicine, Marmara Üniversitesi Göztepe Yerleşkesi, Istanbul 34854, Turkey.
Received: February 11, 2021
Peer-review started: February 11, 2021
First decision: April 18, 2021
Revised: April 28, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: September 7, 2021

Surveillance with abdominal ultrasound with or without alpha-fetoprotein is recommended by clinical practice guidelines for patients who are considered to be at risk of developing hepatocellular carcinoma (HCC), including those with cirrhosis, advanced fibrosis and special subgroups of chronic hepatitis B (CHB). Application of the standard surveillance strategy to all patients with chronic liver disease (CLD) with or without cirrhosis imposes major sustainability and economic burdens on healthcare systems. Thus, a number of HCC risk scores were constructed, mainly from Asian cohorts, to stratify the HCC prediction in patients with CHB. Similarly, even if less than for CHB, a few scoring systems were developed for chronic hepatitis C patients or cirrhotic patients with CLD of different etiologies. Recently, a few newsworthy HCC-risk algorithms were developed for patients with cirrhosis using the combination of serologic HCC markers and clinical parameters. Overall, the HCC risk stratification appears at hand by several validated multiple score systems, but their optimal performance is obtained only in populations who show highly homogenous clinic-pathologic, epidemiologic, etiologic and therapeutic characteristics and this limitation poses a major drawback to their sustainable use in clinical practice. A better understanding of the dynamic process driving the progression from CLD to HCC derived from studies based on molecular approaches and genetics, epigenetics and liquid biopsy will enable the identification of new biomarkers to define the individual risk of HCC in the near future, with the possibility to achieve a real and cost/effective personalization of surveillance.

Keywords: Hepatocellular carcinoma, Surveillance, Chronic viral hepatitis, Risk score, Risk-stratification, Hepatitis B virus, Hepatitis C virus

Core Tip: The risk of hepatocellular carcinoma (HCC) is not uniform and may increase due to underlying parameters in chronic viral hepatitis. Several clinical HCC risk scores and biomarker integrated algorithms have been proposed to stratify patients according to their HCC risk level. In the present review, we summarize the efforts for personalized HCC surveillance in the literature and discuss their applicability to clinical practice.