Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2133
Peer-review started: December 30, 2014
First decision: January 20, 2015
Revised: June 29, 2015
Accepted: August 10, 2015
Article in press: August 11, 2015
Published online: August 28, 2015
Hepatocellular carcinoma (HCC) secondary to chronic viral hepatitis is a major health problem in Asian-Pacific regions due to the endemics of chronic hepatitis B and C virus infection. HCC surveillance has been recommended to patients who are at risk to develop HCC. Unfortunately, a significant proportion of patients still died in long run due to tumor recurrence. The key components of an optimal surveillance program include an accurate tumor biomarker and optimal surveillance interval. Serum alpha-fetoprotein (AFP), despite of being the most widely used biomarker for HCC surveillance, it was criticized as neither sensitive nor specific. Other HCC biomarkers, including lectin-reactive AFP (AFP-L3), des-gamma carboxyprothrombin, are still under investigations. Recent study showed cancer-associated genome-wide hypomethylation and copy number aberrations by plasma DNA bisulfite sequencing to be accurate with both sensitivity and specificity close to 90% in detecting HCC in a case-control study. Concerning the optimal surveillance interval, we believe one size does not fit all patients. Accurate risk prediction to assist prognostication with well-validated HCC risk scores would be useful to decide the need for HCC surveillance. These key components of an optimal HCC surveillance program should be further validated at a surveillance setting.
Core tip: The key components of an optimal surveillance program include an accurate tumor biomarker and optimal surveillance interval for hepatocellular carcinoma (HCC). Cancer-associated genome-wide hypomethylation and copy number aberrations by plasma DNA bisulfite sequencing are two promising genomic markers of HCC. Risk prediction by HCC risk scores may assist prognostication and to decide the optimal surveillance interval.