Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 28, 2015; 7(18): 2133-2135
Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2133
Optimal surveillance program for hepatocellular carcinoma - getting ready, but not yet
Grace Lai-Hung Wong
Grace Lai-Hung Wong, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
Grace Lai-Hung Wong, Institute of Digestive Disease, the Chinese University of Hong Kong, Hong Kong, China
Grace Lai-Hung Wong, State Key Laboratory of Digestive Disease, the Chinese University of Hong Kong, Hong Kong, China
Author contributions: Wong GLH was responsible for the conception, writing, review and revision of the manuscript.
Conflict-of-interest statement: Grace Lai-Hung Wong has served as an advisory committee member for Otsuka and Gilead. She has also served as a speaker for Abbvie, Bristol-Myers Squibb, Echosens, Furui, Gilead and Otsuka.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Grace Lai-Hung Wong, MD, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, the Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, China. wonglaihung@cuhk.edu.hk
Telephone: +852-26323538 Fax: +852-26373852
Received: December 29, 2014
Peer-review started: December 30, 2014
First decision: January 20, 2015
Revised: June 29, 2015
Accepted: August 10, 2015
Article in press: August 11, 2015
Published online: August 28, 2015
Processing time: 242 Days and 22.5 Hours
Abstract

Hepatocellular carcinoma (HCC) secondary to chronic viral hepatitis is a major health problem in Asian-Pacific regions due to the endemics of chronic hepatitis B and C virus infection. HCC surveillance has been recommended to patients who are at risk to develop HCC. Unfortunately, a significant proportion of patients still died in long run due to tumor recurrence. The key components of an optimal surveillance program include an accurate tumor biomarker and optimal surveillance interval. Serum alpha-fetoprotein (AFP), despite of being the most widely used biomarker for HCC surveillance, it was criticized as neither sensitive nor specific. Other HCC biomarkers, including lectin-reactive AFP (AFP-L3), des-gamma carboxyprothrombin, are still under investigations. Recent study showed cancer-associated genome-wide hypomethylation and copy number aberrations by plasma DNA bisulfite sequencing to be accurate with both sensitivity and specificity close to 90% in detecting HCC in a case-control study. Concerning the optimal surveillance interval, we believe one size does not fit all patients. Accurate risk prediction to assist prognostication with well-validated HCC risk scores would be useful to decide the need for HCC surveillance. These key components of an optimal HCC surveillance program should be further validated at a surveillance setting.

Keywords: Antiviral therapy; Biomarkers; Hepatocellular carcinoma; Hepatocellular carcinoma risk scores; Liver stiffness measure; Surveillance program

Core tip: The key components of an optimal surveillance program include an accurate tumor biomarker and optimal surveillance interval for hepatocellular carcinoma (HCC). Cancer-associated genome-wide hypomethylation and copy number aberrations by plasma DNA bisulfite sequencing are two promising genomic markers of HCC. Risk prediction by HCC risk scores may assist prognostication and to decide the optimal surveillance interval.