Evaluation and impact of different biomarkers for early detection of hepatocellular carcinoma

Abstract

Worldwide, hepatocellular carcinoma (HCC) is a frequent complication of liver diseases and remains a major cause of cancer-related mortality. In addition, the prevalence of nonalcoholic steatohepatitis (NASH) as prerequisite of hepatocarcinogenesis, even in the absence of cirrhosis, is rising rapidly. The early detection of HCC has been crucial in improving the survival outcomes of those patients. However, in the mostly obese NASH population, diagnostic sensitivity of ultrasound-based HCC screening approaches is limited. On the other hand, biomarkers for HCC show promising potential to improve early detection, providing reproducible, investigator-independent results that can be used either alone or integrated with other biomarkers for scoring models. In the past, validation has been limited due to a lack of prospective longitudinal cohort studies. At present, large-scale retrospective phase-III-biomarker-development gives hope for the availability of biomarker-based screening approaches in the near future. This review focuses on the potential impact of biomarkers on surveillance strategies, potentially allowing for earlier HCC diagnosis.

Diagnostic accuracy of serum protein induced by vitamin K absence (PIVKA‐II), serum a‐fetoprotein and their combination for hepatocellular carcinoma among Caucasian cirrhotic patients with diagnostic or non‐diagnostic serum a‐fetoprotein levels

“…US limitations in the early detection of HCC have been recognized in many studies, particularly in obese patients with nonalcoholic fatty liver disease (NAFLD) 10,11 . US alone has low sensitivity in early HCC detection, which is a fact that emphasizes the importance of determining whether other serum biomarkers might complement AFP and US in the surveillance setting 11,12 . Data concerning the utility of several proposed tumor biomarkers and/or their combination for accurate early HCC detection in cirrhotic patients is still needed.…”

Augmenting care in hepatocellular carcinoma with artificial intelligence

“…While the past decade has seen paradigm shifts in the way HCC is diagnosed and treated [2,3] , prognosis remains poor (5-year overall survival stands at less than 20% [4] ) owing to multiple factors including the difficulty in identifying HCC in its early stages [5] . Early surveillance of highrisk patients is done via six-monthly abdominal ultrasound and serum α-fetoprotein (AFP) measurements [6] , but both confer limited accuracy in identifying early-stage HCC, where nodules are small and indeterminate [7,8] . Sensitivity is particularly low in patients with underlying cirrhosis, steatosis, or obesity [7,8] .…”