Review Article: Cancer Surveillance for Early Detection of Liver Cancer in Patients with HBV Infection.
Authors
Affiliations (6)
Affiliations (6)
- College of Arts and Sciences, Washington University, St Louis, Missouri, USA.
- Department of Psychology, Queens College, Queens, New York, USA.
- Department of Infectious Diseases, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
- Northwell Center for Liver Disease and Transplantation, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra and Northwell, New York, USA.
- Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, USA.
Abstract
Chronic hepatitis B virus (HBV) infection remains a major cause of hepatocellular carcinoma (HCC). Although antiviral therapy reduces cirrhosis and liver failure, HCC may still develop in patients with HBV, including in non-cirrhotic livers. This review aimed to evaluate current HCC surveillance strategies in HBV infection, focusing on risk stratification and advances in early detection. English-language literature published in PubMed and the Cochrane Database was comprehensively reviewed. This narrative review assessed the effectiveness of HCC surveillance strategies in HBV-infected patients, with emphasis on recent advances in early-stage HCC detection. This review summarizes viral, host and environmental factors associated with HCC susceptibility and evaluates current surveillance using ultrasound with or without alpha-fetoprotein (AFP). Surveillance eligibility should follow guideline-defined risk criteria: patients with an estimated annual HCC risk below 0.2% generally do not require routine surveillance and should undergo periodic risk reassessment, whereas patients meeting surveillance criteria should undergo ultrasound with or without AFP every 6 months. Risk-prediction scores can refine assessment but should be distinguished from early-detection tests. GALAD, HES 2.0, multi-target blood tests, and abbreviated magnetic resonance imaging are promising early-detection approaches, but much of the supporting evidence derives from mixed-aetiology or non-HBV cohorts and prospective HBV-specific validation remains limited. A risk-adapted approach should separate estimation of future HCC risk from surveillance and early-detection testing. Guideline-eligible patients should undergo surveillance every 6 months, while emerging biomarker, imaging and artificial-intelligence approaches remain adjunctive or investigational pending further HBV-specific validation.