Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Abstract

Purpose of review Current clinical practice guidelines recommend regular hepatocellular carcinoma (HCC) surveillance with biannual ultrasound with or without serum alpha-fetoprotein uniformly applied to all patients with cirrhosis. However, clinical implementation of this one-size-fits-all strategy has been challenging as evidenced by very low application rate below 20% due to various reasons, including suboptimal performance of the surveillance modalities. Recent findings Newly emerging imaging techniques such as abbreviated MRI (AMRI) and molecular HCC risk biomarkers have increasingly become available for clinical evaluation and implementation. These technologies may have a potential to reshape HCC surveillance by enabling tailored strategies. This would involve performing optimized surveillance tests according to individual HCC risk, and allocating limited medical resources for HCC surveillance based on cost-effectiveness. Summary Tailored HCC surveillance could lead to achievement of precision HCC care and substantial improvement of the current dismal patient prognosis.

Cost-Utility Analysis of Imaging for Surveillance and Diagnosis of Hepatocellular Carcinoma

“…New technologies have introduced us to the era of individualized medicine, particularly in the oncological field. Our findings support this perspective and are in accordance with previously published studies [18,190,191].…”

Clinical and molecular sub-classification of hepatocellular carcinoma relative to alpha-fetoprotein level in an Asia-Pacific island cohort

“…Recent attempts at HCC molecular sub-classification have produced multiple, sometimes orthogonal, classification systems that associate with various clinical, histological, and molecular features [ 8 – 12 ] . The molecular diversity of HCC makes targeted therapy challenging, since it dilutes any individual therapeutic target within the patient population, leading to weaker overall benefit in conventional clinical trials [ 13 – 15 ] . Consequently, it is not surprising that among HCC clinical trials to date, all molecularly-specific agents have failed, and only multi-targeting agents such as sorafenib have shown efficacy [ 16 ] .…”

“…Consequently, it is not surprising that among HCC clinical trials to date, all molecularly-specific agents have failed, and only multi-targeting agents such as sorafenib have shown efficacy [ 16 ] . A robust molecular sub-classification system for HCC could enable clinical trials to enrich study cohorts according to tumoral expression of targeted molecular pathways [ 11 , 15 – 17 ] . In fact, this may be the most important next step in advancing patient-individualized treatment of HCC.…”

Cancer screening in Australia: future directions in melanoma, Lynch syndrome, and liver, lung and prostate cancers

“…The population may also be too broad, and higher-risk groups could be identified using age, gender, aetiology, fibrosis stage and new specific molecular biomarkers. 46 More important, however, is the low rate of participation in regular surveillance of the at-risk population. In a population-based cohort of patients diagnosed with HCC in Australia, only 40% participated in regular surveillance.…”