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

Table 7 Hepatocellular carcinoma surveillance in hepatitis C virus infected patients

HCC surveillance in HCV infected patients
Western medical societies
EASL, 2018	High-risk patients: HCV-related cirrhosis. Chronic hepatitis C and stage	Screening with US examination with or without AFP every 6 mo for high-risk patients (incidence > 1.5%/yr)
AASLD, 2018	High-risk patients: HCV-related cirrhosis. Chronic hepatitis C and stage 3 fibrosis	Screening with US examination with or without AFP every 6 mo for high-risk group (incidence > 1.5%/yr)
Eastern medical societies
JSH, 2017-2021	Extremely-high-risk patients: All patients with HCV-related cirrhosis. High-risk patients: Patients with chronic hepatitis C	Screening with US and tumor marker measurements (AFP, PIVKA-II and AFP-L3) every 3-4 mo in the super-high-risk population. A 6-12 mo dynamic CT scan, dynamic MRI should be performed or Sonazoid CEUS. Screening every 6 mo in high-risk populations
APASL, 2017	High-risk patients: All patients with HCV-related cirrhosis. SVR patients with chronic hepatitis C with advanced liver fibrosis, independently of the histologic response to therapy. SVR patients with chronic hepatitis C with any histologic stage of HCV with comorbidities, such as alcohol abuse and DM	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, 2014-2018	High-risk patients: All patients with HCV-related cirrhosis. Patients with chronic hepatitis C and advanced fibrosis	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 as an alternative

HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; US: Ultrasound; AFP: Alpha-fetoprotein; SVR: Sustained virological response; PIVKA-II: Protein induced vitamin K absence or antagonist-II; CEUS: Contrast enhanced ultrasound; CT: Computed tomography; MRI: Magnetic resonance imaging; 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.