Hepatocellular Carcinoma Over Three Decades: from Screening Evolution to Integrated Therapeutic Strategies

Area of Science:

• Hepatology and Oncology
• Medical Diagnostics and Therapeutics
• Public Health and Epidemiology

Background:

• Hepatocellular carcinoma (HCC) presents a significant global health challenge, with incidence and mortality rates remaining high despite diagnostic and therapeutic progress.
• Over 30 years, HCC surveillance evolved from single-marker tests to risk-stratified assessments, and treatments shifted from local therapies to integrated radiologic and immunologic approaches.
• Despite these advancements, population-level benefits are limited by persistently low early detection rates in many regions.

Purpose of the Study:

• To provide a comprehensive review of the evolution of HCC surveillance and treatment over the past three decades.
• To highlight innovations in biomarkers, imaging, and systemic therapies that have reshaped clinical practice.
• To identify persistent barriers hindering the real-world impact of these advancements and propose future strategies.

Main Methods:

• Synthesis of epidemiologic trends, clinical evidence, and technological advancements in HCC management.
• Review of the historical progression of screening technologies and therapeutic strategies for HCC.
• Analysis of challenges including metabolic disease imaging, surveillance adherence, and healthcare access disparities.

Main Results:

• Innovations in biomarker discovery, imaging standardization, and systemic therapies have significantly altered HCC clinical practice.
• Key barriers to effective HCC management include challenges in imaging metabolic diseases, inconsistent patient adherence to long-term surveillance, and significant healthcare access disparities.
• The effectiveness of HCC management hinges more on timely patient identification and intervention within the curative window than on the mere availability of sophisticated technologies.

Conclusions:

• Meaningful improvements in HCC outcomes necessitate a shift from solely relying on advanced tools to prioritizing the timely identification and management of patients.
• Future strategies for HCC prevention and control should be precision-based, equitable, and multimodal, addressing current limitations.
• Integrating epidemiologic data, clinical evidence, and technological progress is crucial for developing effective, accessible HCC care pathways.