Abstract IA08: Systematic approach to HCC surveillance in patients with cirrhosis
Authors: Singal Amit 
Published: September 2022

Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of death worldwide and one of the few cancers with a rising mortality in the United States. Given the stark contrast in treatment options and expected survival based on tumor stage at diagnosis, professional society guidelines recommend HCC surveillance in high-risk groups, including subsets with chronic HBV infection and those with cirrhosis from any etiology. These target populations, particularly those with cirrhosis, account for &gt;90% of HCC in the Western world, as patients without chronic liver disease have a very low risk of developing HCC. The best data for HCC surveillance comes from a large randomized clinical trial among &gt;18,00 patients with HBV infection from China; however, similar level I data does not exist supporting HCC surveillance in patients with cirrhosis. A meta-analysis of recent cohort studies highlights a consistent association between surveillance receipt and improved clinical outcomes in patients with cirrhosis, including early detection, curative treatment receipt, and overall survival. Despite these recommendations, most HCC continue to be diagnosed at an advanced stage. We will discuss failures in our current surveillance strategies that must be addressed to improve HCC surveillance effectiveness and reduce HCC mortality. First, most professional societies recommend ultrasound-based surveillance, which is operator dependent and has suboptimal sensitivity for early HCC detection – missing approximately half of early-stage HCC if used alone and approximately one-third if used in combination with AFP. Several imaging- and blood-based surveillance strategies (e.g., abbreviated MRI, GALAD, and methylated DNA marker panels) have promising accuracy for early-stage HCC detection, although large prospective validation in diverse patient cohorts are still needed. Second, HCC surveillance is underused in clinical practice, with a recent systematic review finding only one-fourth of at-risk patients are undergoing surveillance, with even lower estimates when considering consistent semi-annual surveillance over extended periods of time. Surveillance underuse is related to several patient- and provider-barriers, which must be addressed to increased utilization. Notably, some barriers appear to be specific to imaging-based surveillance so validation of blood-based biomarkers may also improve utilization and maximize surveillance effectiveness. Several inreach and outreach interventions have demonstrated efficacy to increase HCC surveillance, and studies are now needed to evaluate how best to implement these interventions in clinical practice. Although HCC continues to have a poor overall prognosis, there have been dramatic advances in all three of these areas, highlighting promise for improved outcomes in the near future.
Citation Format: Amit Singal. Systematic approach to HCC surveillance in patients with cirrhosis [abstract]. In: Proceedings of the AACR Special Conference: Advances in the Pathogenesis and Molecular Therapies of Liver Cancer; 2022 May 5-8; Boston, MA. Philadelphia (PA): AACR; Clin Cancer Res 2022;28(17_Suppl):Abstract nr IA08.