Viral hepatitis and hepatocellular carcinoma: From molecular pathways to the role of clinical surveillance and antiviral treatment

Table 4 Hepatocellular carcinoma surveillance in hepatitis B virus infected patients

HCC surveillance in HBV-infected patients
Western medical societies
EASL, 2017	High-risk-patients: (1) HBV cirrhotic patients; (2) HBV and F3 fibrosis; and (3) HBsAg-positive patient on NA treatment with a PAGE-B of ≥ 18 at the onset of therapy. Medium risk-patients: HBsAg-positive patient on NA treatment with a PAGE-B of 10 - 17 at the onset of therapy	Screening with US examination with or without AFP every 6 mo for medium and high-risk patients. No specific HCC screening needed for low-risk patients
AASLD, 2018	High-risk patients: (1) HBV cirrhotic patients; (2) Special population of HBsAg-positive adults: Asian or African men (> 40 yr) and Asian women (> 50 yr), first-degree family member with a history of HCC, HDV coinfected; and (3) HBsAg-positive children/adolescents with advanced F3 or cirrhosis and first-degree family member with HCC	Screening with US examination with or without AFP every 6 mo; if in areas where US is not readily available, screening with AFP every 6 mo
Eastern medical societies
JSH, 2014-2021	Extremely-high-risk patients: HBV cirrhotic patients. High-risk patients: Special population of HBsAg positive patients: age ≥ 40, male, alcohol consumption, high HBV load, family history of HCC, HCV/HDV/HIV coinfection, F3 fibrosis, low platelet count associated with advanced fibrosis, genotype C, and core promoter mutation	Screening with US and tumor marker measurements (AFP, protein induced by vitamin K absence or antagonist-II and AFP-lectin fraction 3) every 3-4 mo in the super-high-risk population. A 6-12 mo dynamic CT scan or dynamic MRI should be performed. Screening every 6 mo in high-risk populations
APASL, 2016	High-risk patients: All patients with HBV-related cirrhosis. HBsAg-positive without cirrhosis, based on the economic situation of each country and on the available risk scores	Surveillance by US and AFP should be performed every 6 mo and preferably every 3-4 mo in cirrhotic patients and those at high risk of HCC
KLCSG, 2014-18	High-risk patients: HBV cirrhotic patients; chronic hepatitis B patients	Screening with US examination with or without AFP every 6 mo. If liver US cannot be performed properly, liver dynamic CT or dynamic contrast-enhanced MRI can be performed

HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HDV: Hepatitis D virus; HIV: Human immunodeficiency virus; EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases; JSH: Japan Society of Hepatology; APASL: The Asian Pacific Association for the Study of the Liver; KLCSG: Korean Liver Cancer Study Group; US: Ultrasound; AFP: Alpha-fetoprotein; F3: Fibrosis; HBsAg: Hepatitis B virus surface antigen; CT: Computed tomography; MRI: Magnetic resonance imaging.