Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Häufige urologisch-sexualmedizinische Themen in der Praxis sind das Thema des MMW-Webinars am 5. Juni von 17.30 bis 19 Uhr. Konkret geht es um die Frage, wann bei Harnwegsinfektionen auf Antibiotika verzichtet werden kann, und um ein Update zur Therapie von Libido- und Potenzstörungen des Mannes. Der dritte Vortrag behandelt sexuell übertragbare Krankheiten. Stellen Sie Ihre Fragen an die Experten und sammeln Sie 2 CME-Punkte. Jetzt gleich anmelden!
Erweiterte Suche
Anmelden
nach oben
Current Hepatology Reports
Erschienen in: Current Hepatology Reports 1/2024

17.01.2024

Update on HCC Surveillance in Patient With Hepatitis B Virus Infection With Focus on Biomarkers

verfasst von: John Grady, Neehar D. Parikh

Erschienen in: Current Hepatology Reports | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Chronic hepatitis B (CHB) infection is a major risk factor for hepatocellular carcinoma (HCC) worldwide. Current guidelines recommend HCC surveillance in individuals with cirrhosis and certain CHB subgroups using ultrasound with alpha-fetoprotein (AFP). However, ultrasound-based screening is limited by suboptimal sensitivity, operator and patient variability, and poor adherence. Risk scores and biomarker-based screening modalities have emerged as an alternative surveillance strategy. The purpose of this review is to summarize HCC surveillance in CHB patients, including the literature regarding risk stratification scores and emerging biomarkers.

Recent Findings

Risk stratification tools, including the PAGE-B, REAL-B, and CAMD can identify CHB patients at high risk of HCC and may play a role in selecting appropriate patients to screen for HCC. AFP is the most widely studied biomarker in CHB, although DCP and the GALAD score show promise.

Summary

Risk stratification tools have been well validated in CHB, but biomarkers remain inadequately validated to recommend routine use for HCC surveillance.
Literatur
1.
Lim JK, Nguyen MH, Kim WR, Gish R, Perumalswami P, Jacobson IM. Prevalence of chronic hepatitis B virus infection in the United States. Am J Gastroenterol. 2020;115(9):1429–38.PubMedCrossRef
2.
Roberts H, Ly KN, Yin S, Hughes E, Teshale E, Jiles R. Prevalence of HBV infection, vaccine-induced immunity, and susceptibility among at-risk populations: US households, 2013–2018. Hepatology. 2021;74(5):2353–65.PubMedCrossRef
3.
Wong RJ, Brosgart CL, Welch S, Block T, Chen M, Cohen C, et al. An updated assessment of chronic hepatitis B prevalence among foreign-born persons living in the United States. Hepatology. 2021;74(2):607–26.PubMedCrossRef
4.
Global Burden of Disease Liver Cancer C, Akinyemiju T, Abera S, Ahmed M, Alam N, Alemayohu MA, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: Results from the global burden of disease study 2015. JAMA Oncol. 2017;3(12):1683–91.
5.
••Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, Jou JH, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023:10.1097. The most recently published professional guidelines on hepatocellular carcinoma.
6.
••EASL clinical practice guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236. Evidence-based professional guidelines on hepatocellular carcinoma.
7.
••Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: A 2017 update. Hepatol Int. 2017;11(4):317–70. Evidence-based professional guidelines on hepatocellular carcinoma.
8.
Yang JD, Gyedu A, Afihene MY, Duduyemi BM, Micah E, Kingham TP, et al. Hepatocellular carcinoma occurs at an earlier age in africans, particularly in association with chronic hepatitis B. Am J Gastroenterol. 2015;110(11):1629–31.PubMedCrossRef
9.
Yang JD, Mohamed EA, Aziz AO, Shousha HI, Hashem MB, Nabeel MM, et al. Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: A multicountry observational study from the Africa liver cancer consortium. Lancet Gastroenterol Hepatol. 2017;2(2):103–11.PubMedCrossRef
10.
Yang JD, Altekruse SF, Nguyen MH, Gores GJ, Roberts LR. Impact of country of birth on age at the time of diagnosis of hepatocellular carcinoma in the United States. Cancer. 2017;123(1):81–9.PubMedCrossRef
11.
••Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma.J Cancer Res Clin Oncol. 2004;130(7):417–22. Large randomized controlled trial that serves as the strongest evidence for HCC surveillance.
12.
Lederle FA, Pocha C. Screening for liver cancer: The rush to judgment. Ann Intern Med. 2012;156(5):387–9.PubMedCrossRef
13.
•Singal AG, Zhang E, Narasimman M, Rich NE, Waljee AK, Hoshida Y, et al. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022;77(1):128–39. Recently published large meta-analysis demonstrating that HCC surveillance in patients with cirrhosis is associated with improved outcomes.
14.
•Singal AG, Sanduzzi-Zamparelli M, Nahon P, Ronot M, Hoshida Y, Rich N, et al. International Liver Cancer Association (ILCA) white paper on hepatocellular carcinoma risk stratification and surveillance. J Hepatol. 2023;79(1):226–39. Recently published evidence-based white paper discussing HCC surveillance, HCC risk stratification scores, and biomarkers in the general screening population.
15.
Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: A meta-analysis. Gastroenterology. 2018;154(6):1706-18.e1.PubMedCrossRef
16.
Schoenberger H, Chong N, Fetzer DT, Rich NE, Yokoo T, Khatri G, et al. Dynamic changes in ultrasound quality for hepatocellular carcinoma screening in patients with cirrhosis. Clin Gastroenterol Hepatol. 2022;20(7):1561-9.e4.PubMedCrossRef
17.
Wolf E, Rich NE, Marrero JA, Parikh ND, Singal AG. Use of hepatocellular carcinoma surveillance in patients with cirrhosis: A systematic review and meta-analysis. Hepatology. 2021;73(2):713–25.PubMedCrossRef
18.
Kim SY, An J, Lim YS, Han S, Lee JY, Byun JH, et al. MRI with liver-specific contrast for surveillance of patients with cirrhosis at high risk of hepatocellular carcinoma. JAMA Oncol. 2017;3(4):456–63.PubMedPubMedCentralCrossRef
19.
Yoon JH, Lee JM, Lee DH, Joo I, Jeon JH, Ahn SJ, et al. A comparison of biannual two-phase low-dose liver CT and US for HCC surveillance in a Group at High Risk of HCC development. Liver Cancer. 2020;9(5):503–17.PubMedPubMedCentralCrossRef
20.
Park HJ, Kim SY, Singal AG, Lee SJ, Won HJ, Byun JH, et al. Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high-risk patients. Liver Int. 2022;42(9):2080–92.PubMedCrossRef
21.
Papatheodoridis G, Dalekos G, Sypsa V, Yurdaydin C, Buti M, Goulis J, et al. PAGE-B predicts the risk of developing hepatocellular carcinoma in caucasians with chronic hepatitis B on 5-year antiviral therapy. J Hepatol. 2016;64(4):800–6.PubMedCrossRef
22.
Kim MN, Hwang SG, Rim KS, Kim BK, Park JY, Kim DY, et al. Validation of PAGE-B model in asian chronic hepatitis B patients receiving entecavir or tenofovir. Liver Int. 2017;37(12):1788–95.PubMedCrossRef
23.
Seo YS, Jang BK, Um SH, Hwang JS, Han KH, Kim SG, et al. Validation of risk prediction models for the development of HBV-related HCC: A retrospective multi-center 10-year follow-up cohort study. Oncotarget. 2017;8(68):113213–24.PubMedPubMedCentralCrossRef
24.
•Wu S, Zeng N, Sun F, Zhou J, Wu X, Sun Y, et al. Hepatocellular carcinoma prediction models in chronic hepatitis B: A systematic review of 14 models and external validation. Clin Gastroenterol Hepatol. 2021;19(12):2499–513. Large meta-analysis evaluating the performance of risk stratification scores in CHB.
25.
Yang HI, Yeh ML, Wong GL, Peng CY, Chen CH, Trinh HN, et al. Real-world effectiveness from the Asia Pacific rim liver consortium for HBV risk score for the prediction of hepatocellular carcinoma in chronic hepatitis B patients treated with Oral antiviral therapy. J Infect Dis. 2020;221(3):389–99.PubMedCrossRef
26.
Kim HS, Yu X, Kramer J, Thrift AP, Richardson P, Hsu YC, et al. Comparative performance of risk prediction models for hepatitis B-related hepatocellular carcinoma in the United States. J Hepatol. 2022;76(2):294–301.PubMedCrossRef
27.
Hsu YC, Yip TC, Ho HJ, Wong VW, Huang YT, El-Serag HB, et al. Development of a scoring system to predict hepatocellular carcinoma in Asians on antivirals for chronic hepatitis B. J Hepatol. 2018;69(2):278–85.PubMedCrossRef
28.
Kim SU, Seo YS, Lee HA, Kim MN, Kim EH, Kim HY, et al. Validation of the CAMD score in patients with chronic hepatitis B virus infection receiving antiviral therapy. Clin Gastroenterol Hepatol. 2020;18(3):693-9.e1.PubMedCrossRef
29.
Yuen MF, Tanaka Y, Fong DY, Fung J, Wong DK, Yuen JC, et al. Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B. J Hepatol. 2009;50(1):80–8.PubMedCrossRef
30.
Wong VW, Chan SL, Mo F, Chan TC, Loong HH, Wong GL, et al. Clinical scoring system to predict hepatocellular carcinoma in chronic hepatitis B carriers. J Clin Oncol. 2010;28(10):1660–5.PubMedCrossRef
31.
Yang HI, Yuen MF, Chan HL, Han KH, Chen PJ, Kim DY, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): Development and validation of a predictive score. Lancet Oncol. 2011;12(6):568–74.PubMedCrossRef
32.
Jung KS, Kim SU, Ahn SH, Park YN, Kim DY, Park JY, et al. Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using liver stiffness measurement (FibroScan). Hepatology. 2011;53(3):885–94.PubMedCrossRef
33.
Wong GL, Chan HL, Wong CK, Leung C, Chan CY, Ho PP, et al. Liver stiffness-based optimization of hepatocellular carcinoma risk score in patients with chronic hepatitis B. J Hepatol. 2014;60(2):339–45.PubMedCrossRef
34.
Ioannou GN, Tang W, Beste LA, Tincopa MA, Su GL, Van T, et al. Assessment of a deep learning model to predict hepatocellular carcinoma in patients with hepatitis C cirrhosis. JAMA Netw Open. 2020;3(9):e2015626.PubMedPubMedCentralCrossRef
35.
Wong GL, Hui VW, Tan Q, Xu J, Lee HW, Yip TC, et al. Novel machine learning models outperform risk scores in predicting hepatocellular carcinoma in patients with chronic viral hepatitis. JHEP Rep. 2022;4(3):100441.PubMedPubMedCentralCrossRef
36.
•Parikh ND, Tayob N, Singal AG. Blood-based biomarkers for hepatocellular carcinoma screening: Approaching the end of the ultrasound era? J Hepatol. 2023;78(1):207–16. Recently published comprehensive review of biomarker use in HCC surveillance.
37.
Lok AS, Lai CL. alpha-fetoprotein monitoring in chinese patients with chronic hepatitis B virus infection: Role in the early detection of hepatocellular carcinoma. Hepatology. 1989;9(1):110–5.PubMedCrossRef
38.
Lee HS, Chung YH, Kim CY. Specificities of serum alpha-fetoprotein in HBsAg+ and HBsAg- patients in the diagnosis of hepatocellular carcinoma. Hepatology. 1991;14(1):68–72.PubMedCrossRef
39.
Kim GA, Seock CH, Park JW, An J, Lee KS, Yang JE, et al. Reappraisal of serum alpha-foetoprotein as a surveillance test for hepatocellular carcinoma during entecavir treatment. Liver Int. 2015;35(1):232–9.PubMedCrossRef
40.
Shim JJ, Kim JW, Lee CK, Jang JY, Kim BH. Oral antiviral therapy improves the diagnostic accuracy of alpha-fetoprotein levels in patients with chronic hepatitis B. J Gastroenterol Hepatol. 2014;29(9):1699–705.PubMedCrossRef
41.
Wong GL, Chan HL, Tse YK, Chan HY, Tse CH, Lo AO, Wong VW. On-treatment alpha-fetoprotein is a specific tumor marker for hepatocellular carcinoma in patients with chronic hepatitis B receiving entecavir. Hepatology. 2014;59(3):986–95.PubMedCrossRef
42.
Choi J, Tayob N, Lim YS. Detecting early hepatocellular carcinoma in patients with chronic hepatitis B using longitudinal α-fetoprotein screening. Clin Gastroenterol Hepatol. 2023;21(6):1590–7.PubMedCrossRef
43.
Choi J, Kim GA, Han S, Lee W, Chun S, Lim YS. Longitudinal assessment of three serum biomarkers to detect very early-stage hepatocellular carcinoma. Hepatology. 2019;69(5):1983–94.PubMedCrossRef
44.
Chang TS, Wu YC, Tung SY, Wei KL, Hsieh YY, Huang HC, et al. Alpha-Fetoprotein measurement benefits hepatocellular carcinoma surveillance in patients with cirrhosis. Am J Gastroenterol. 2015;110(6):836–44; quiz 45.
45.
Taketa K, Endo Y, Sekiya C, Tanikawa K, Koji T, Taga H, et al. A collaborative study for the evaluation of lectin-reactive alpha-fetoproteins in early detection of hepatocellular carcinoma. Cancer Res. 1993;53(22):5419–23.PubMed
46.
Marrero JA, Feng Z, Wang Y, Nguyen MH, Befeler AS, Roberts LR, et al. Alpha-fetoprotein, des-gamma carboxyprothrombin, and lectin-bound alpha-fetoprotein in early hepatocellular carcinoma. Gastroenterology. 2009;137(1):110–8.PubMedCrossRef
47.
Tayob N, Kanwal F, Alsarraj A, Hernaez R, El-Serag HB. The performance of AFP, AFP-3, DCP as biomarkers for detection of hepatocellular carcinoma (HCC): A phase 3 biomarker study in the United States. Clin Gastroenterol Hepatol. 2023;21(2):415-23.e4.PubMedCrossRef
48.
Liebman HA, Furie BC, Tong MJ, Blanchard RA, Lo KJ, Lee SD, et al. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med. 1984;310(22):1427–31.PubMedCrossRef
49.
Ji J, Wang H, Li Y, Zheng L, Yin Y, Zou Z, et al. Diagnostic evaluation of des-gamma-carboxy prothrombin versus α-fetoprotein for hepatitis B virus-related hepatocellular carcinoma in China: A large-scale, multicentre study. PLoS One. 2016;11(4):e0153227.PubMedPubMedCentralCrossRef
50.
Loglio A, Iavarone M, Facchetti F, Di Paolo D, Perbellini R, Lunghi G, et al. The combination of PIVKA-II and AFP improves the detection accuracy for HCC in HBV caucasian cirrhotics on long-term oral therapy. Liver Int. 2020;40(8):1987–96.PubMedCrossRef
51.
Lu YC, Su TH, Tseng TC, Hsu SJ, Liao SH, Hong CM, et al. High PIVKA-II level and ASAP score predict 1-year risk of hepatocellular carcinoma in non-cirrhotic chronic hepatitis B patients. Am J Cancer Res. 2023;13(6):2588–97.PubMedPubMedCentral
52.
Piratvisuth T, Tanwandee T, Thongsawat S, Sukeepaisarnjaroen W, Esteban JI, Bes M, et al. Multimarker panels for detection of early stage hepatocellular carcinoma: A prospective, multicenter, Case-Control Study. Hepatol Commun. 2022;6(4):679–91.PubMedCrossRef
53.
Seo SI, Kim HS, Kim WJ, Shin WG, Kim DJ, Kim KH, et al. Diagnostic value of PIVKA-II and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma. World J Gastroenterol. 2015;21(13):3928–35.PubMedPubMedCentralCrossRef
54.
Johnson PJ, Pirrie SJ, Cox TF, Berhane S, Teng M, Palmer D, et al. The detection of hepatocellular carcinoma using a prospectively developed and validated model based on serological biomarkers. Cancer Epidemiol Biomarkers Prev. 2014;23(1):144–53.PubMedCrossRef
55.
Berhane S, Toyoda H, Tada T, Kumada T, Kagebayashi C, Satomura S, et al. Role of the GALAD and BALAD-2 serologic models in diagnosis of hepatocellular carcinoma and prediction of survival in patients. Clin Gastroenterol Hepatol. 2016;14(6):875-86.e6.PubMedCrossRef
56.
Schotten C, Ostertag B, Sowa J-P, Manka P, Bechmann LP, Hilgard G, Marquardt C, et al. GALAD score detects early-stage hepatocellular carcinoma in a European cohort of chronic hepatitis B and C patients. Pharmaceuticals 2021;14(8):735.
57.
Huang C, Fang M, Xiao X, Wang H, Gao Z, Ji J, et al. Validation of the GALAD model for early diagnosis and monitoring of hepatocellular carcinoma in Chinese multicenter study. Liver Int. 2022;42(1):210–23.PubMedCrossRef
58.
Glinka A, Wu W, Delius H, Monaghan AP, Blumenstock C, Niehrs C. Dickkopf-1 is a member of a new family of secreted proteins and functions in head induction. Nature. 1998;391(6665):357–62.PubMedCrossRef
59.
Shen Q, Fan J, Yang XR, Tan Y, Zhao W, Xu Y, et al. Serum DKK1 as a protein biomarker for the diagnosis of hepatocellular carcinoma: A large-scale, multicentre study. Lancet Oncol. 2012;13(8):817–26.PubMedCrossRef
60.
Jang ES, Jeong SH, Kim JW, Choi YS, Leissner P, Brechot C. Diagnostic performance of alpha-fetoprotein, protein induced by vitamin K absence, osteopontin, Dickkopf-1 and its combinations for hepatocellular carcinoma. PLoS One. 2016;11(3):e0151069.PubMedPubMedCentralCrossRef
61.
Xu RH, Wei W, Krawczyk M, Wang W, Luo H, Flagg K, et al. Circulating tumour DNA methylation markers for diagnosis and prognosis of hepatocellular carcinoma. Nat Mater. 2017;16(11):1155–61.PubMedCrossRef
62.
Lin N, Lin Y, Xu J, Liu D, Li D, Meng H, et al. A multi-analyte cell-free DNA-based blood test for early detection of hepatocellular carcinoma. Hepatol Commun. 2022;6(7):1753–63.PubMedPubMedCentralCrossRef
Metadaten
Titel
Update on HCC Surveillance in Patient With Hepatitis B Virus Infection With Focus on Biomarkers
verfasst von
John Grady
Neehar D. Parikh
Publikationsdatum
17.01.2024
Verlag
Springer US
Erschienen in
Current Hepatology Reports / Ausgabe 1/2024
Elektronische ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-024-00631-0

Weitere Artikel der Ausgabe 1/2024

Current Hepatology Reports 1/2024 Zur Ausgabe

ReviewPaper

Prophylaxis and Treatment of Bacterial Infections in Cirrhosis

ReviewPaper

Cholestatic Pruritus: Pathophysiology, Current Management Approach, and Emerging Therapies

ReviewPaper

Addiction and Liver Disease: Exploring the Complex Relationship and Implications for Clinical Management

ReviewPaper

Endocrinology for the Hepatologist

ReviewPaper

Current Management of Hepatic Encephalopathy

Review

Systemic Disease and Portal Hypertension

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise