HCC surveillance of patients with chronic viral hepatitis

Background Patients with chronic viral hepatitis are at increased risk for hepatocellular carcinoma (HCC). HCC surveillance plays an important role to detect HCC in the early stages and thus enable curative treatment options and improve prognosis. Objectives Patient selection, examination methods, and optimal interval of HCC surveillance in patients with chronic viral hepatitis are evaluated. Methods Current German and European guidelines for hepatitis B and C as well as HCC were assessed and a literature search was performed. Results Patients with advanced fibrosis (METAVIR F3) and cirrhosis should be examined every 6 months by sonography and optional determination of alpha-fetoprotein (AFP). In addition, patients with chronic hepatitis B virus (HBV) infection and moderate or high risk for HCC should be included in HCC surveillance. The PAGE-B score and the listing of risk factors in the German guidelines for hepatitis B can be helpful in patient selection. Even after successful therapy leading to viral elimination of hepatitis C virus infection or virus control of HBV infection, the risk for HCC continues to be increased in patients with F3 fibrosis or cirrhosis and these patients should remain in an HCC surveillance program. Conclusions In addition to antiviral therapy, consequent HCC surveillance is essential for the prognosis of patients with F3 fibrosis or cirrhosis, since only early diagnosis of HCC enables curative treatment.