Review Article: Cancer Surveillance for Early Detection of Liver Cancer in Patients with HBV Infection
Andrew J. Park, Bai L. Pan, Xingfei Pan, James Park, Jiahong Dong, Calvin Q. PanABSTRACT
Background and Aims
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.
Methods
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.
Results
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.
Conclusion
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.