AGA Clinical Practice Update on Risk Stratification and Emerging Surveillance Strategies for Hepatocellular...

Area of Science:

• Hepatology
• Gastroenterology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a major cause of cancer death, particularly in patients with cirrhosis.
• Current surveillance methods for HCC have limitations in sensitivity and are underutilized.
• The incidence of HCC is increasing in nonviral liver diseases, highlighting the need for improved detection strategies.

Purpose of the Study:

• To provide Best Practice Advice on emerging strategies for HCC risk stratification and surveillance.
• To offer guidance on the optimal use of current and novel approaches to HCC detection.
• To address the challenges in integrating new biomarkers into clinical practice.

Main Methods:

• Expert Review commissioned by the AGA Institute Clinical Practice Updates Committee.
• Guidance based on a review of published literature and expert opinion.
• Development of Best Practice Advice statements without a formal systematic review.

Main Results:

• Preventing cirrhosis is the primary strategy to reduce HCC morbidity and mortality.
• Semiannual ultrasound and alpha-fetoprotein remain the preferred HCC surveillance strategy.
• Novel biomarkers require further validation; current evidence does not support their routine use over guideline-recommended tests.
• Risk-stratification scores for HCC in patients with cirrhosis are largely unvalidated, though some exist for chronic hepatitis B patients without cirrhosis.

Conclusions:

• Focus on cirrhosis prevention and early intervention for liver diseases.
• Continue current semiannual ultrasound and alpha-fetoprotein surveillance for high-risk patients.
• Exercise caution with novel biomarkers and risk-stratification tools until robust validation is achieved.
• Clinicians should consider the potential harms associated with HCC surveillance.