Current status, challenges and future directions for hepatocellular carcinoma surveillance in China

Abstract

In 2020, primary liver cancer ranked as the sixth most common malignancy worldwide, with 905 700 newly-diagnosed cases, and 830 000 deaths with an overall mortality rate of 8.7/100 000, ranking third in in malignant tumors. In Asia, there were 657 000 newly-diagnosed cases and 609 000 deaths, accounting for 72.5% and 73.3% of the global burden, respectively. In China, primary liver cancer is one of the most common malignant tumors, with 410 000 new cases, and 391000 deaths with a mortality rate of 17.2/100 000, ranking the second highest among the causes of cancer deaths. Approximately half of annual global newly-diagnosed cases and deaths of liver cancer occurred in China, leading to an extremely heavy disease burden. Hepatocellular carcinoma (HCC) accounts for 75%-85% of primary liver cancer. The 5-year survival rate of HCC patients is merely 14.1% in China, mainly due to advanced disease stage at the diagnosis in most HCC patients. The low rate of diagnosis of early-stage HCC is one of the most important reasons for the poor treatment outcome of HCC patients. The key to improving the diagnosis of early-stage HCC lies on the effective HCC surveillance. The current surveillance method of “abdominal ultrasound + alpha-fetoprotein” is far from meeting the clinical needs in detecting early-stage HCC, which is faced with many problems, including low implementation rates of HCC screening, poor sensitivity for early-stage HCC, and new challenges posed by profound changes in the underlying etiologies of hepatocellular carcinoma in the past decade. In order to optimize the efficacy of HCC surveillance and improve the prognosis of HCC patients, we must adopt effective strategies, raise the implementation rate of HCC surveillance from the perspectives of patients and healthcare professionals, develope new HCC surveillance tools of higher accuracy and with more convenience, [GALAD(gender, age, AFP-L3, DCP, AFP) score and liquid biopsy]; advocating “individualized” surveillance strategies, stratified enrichment and precise screening to maximize the cost-effectiveness of healthcare resources. As one innovative model for individualized HCC surveillance, “artificial intelligence” in closed-loop precise liver disease management may serve as a strategic choice for disease management in China.

Keywords

• |hepatocellular carcinoma|surveillance|early detection|challenges|coping strategies