Current and new strategies for hepatocellular carcinoma surveillance

Natchaya Polpichai; Chongkonrat Maneenil; Pojsakorn Danpanichkul; Chitchai Rattananukrom; Ashok Choudhury; Yu Jun Wong; Pimsiri Sripongpun; Suthat Liangpunsakul; Apichat Kaewdech

doi:10.1093/gastro/goaf045

Current and new strategies for hepatocellular carcinoma surveillance

Gastroenterol Rep (Oxf). 2025 Jun 6:13:goaf045. doi: 10.1093/gastro/goaf045. eCollection 2025.

Authors

Affiliations

¹ Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA.
² Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
³ Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand.
⁵ Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India.
⁶ Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.
⁷ Duke-NUS Academic Clinical Program, SingHealth, Singapore.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁹ Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁰ Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA.

Abstract

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, particularly among individuals with chronic liver diseases. Early detection through surveillance significantly improves survival rates and current guidelines recommend semiannual ultrasound, with or without alpha-fetoprotein (AFP) testing, for high-risk populations. However, limitations in ultrasound sensitivity, physician adherence, and patient compliance affect the effectiveness of these surveillance efforts. This review explores both current and emerging strategies for HCC surveillance. Individualized surveillance approaches, utilizing risk stratification tools such as the aMAP and PAGE-B scores, enable tailored monitoring based on individual risk profiles, potentially reducing unnecessary screening in low-risk groups. Advanced imaging techniques, including contrast-enhanced ultrasound and abbreviated magnetic resonance imaging, demonstrate improved sensitivity over traditional ultrasound, particularly for early-stage HCC detection. Additionally, combining clinical characteristics with novel HCC biomarkers-such as the Gender, Age, AFP-L3, AFP, and Des-gamma-carboxy prothrombin (GALAD) score; HCC early detection screening score version 2 (HES V2.0) score; Gender, Age, AFP, and Des-gamma-carboxy prothrombin (GAAD) score; and AFP, Sex, Age, and Protein induced by vitamin K absence-II (ASAP) score-has shown higher sensitivity for early detection, with GALAD and HES V2.0 performing particularly well in phase 3 biomarker studies. Emerging molecular diagnostics, including liquid biopsy and genetic markers, also show promise in refining future HCC surveillance protocols. Despite these advancements, a limited number of at-risk patients currently undergo surveillance. Therefore, solutions must focus on enhancing awareness, adherence, and accessibility to surveillance tools. This review discusses various strategies for optimizing HCC surveillance, emphasizing a multifaceted approach that integrates risk-assessment tools, advanced imaging, and novel biomarkers to improve early detection and reduce mortality.

Keywords: GALAD; hepatocellular carcinoma; liver; magnetic resonance imaging; surveillance; ultrasonography.

Publication types

Review