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Optimising HCC Surveillance in HBV-Infected Patients

Optimising HCC Surveillance in HBV-Infected Patients

21 Aug 2021 15:36 15:48
(12 mins)
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Tremendous progress has been made in our understanding of chronic hepatitis B virus (HBV) infection and in its prevention and treatment in the last few decades; however, the global burden of HBV infection remains high. Expanding coverage of universal HBV vaccine, and improving diagnosis and linkage to care are essential to meet the World Health Organization goal of eliminating HBV infection by 2030, a strategy that contributes to the proposed targets for the reduction of chronic viral hepatitis incidence and mortality of 80% and 65% respectively. In order to achieve a reduction of chronic viral hepatitis mortality of 65%, focused effort is of top priority to prevent deaths from the complications of chronic HBV infection. Hepatocellular carcinoma (HCC) is the fifth most common cancer in men and ninth most common in women worldwide. The majority of HCC disease burden (85%) is found in low- and middle-income countries with high prevalence of HBV such as the Asia-Pacific region. This pattern of disease burden places heavy financial needs in the areas where resources for antiviral therapy, HCC surveillance, diagnosis and treatment are often limited. There is therefore an urgent need to develop accurate risk scores for HBV-related HCC to guide patient selection for antiviral therapy and HCC surveillance. Over the last decade, more HCC risk scores have been developed, validated and optimized (e.g. with liver stiffness measurement) in different patient and ethnic groups. Risk scores for treated patients with high negative predictive values would be able to identify patients who may not need HCC surveillance anymore as their HCC risk has been reduced by antiviral therapy. Current HCC risk scores can accurately predict HCC in specific populations, in both treatment-naïve patients and those receiving antiviral therapy. Different levels of care and different intensities of HCC surveillance should be offered according to the risk profile of patients.

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