Liver International, Journal Year: 2025, Volume and Issue: 45(4)
Published: March 14, 2025
Surveillance corresponds to the systematic and repeated action of a screening test during time with goal improving survival [1]. In hepatocellular carcinoma (HCC) realm, surveillance aims reduce risk cancer-related death through detection treatment HCC at an early stage. However, recommend or not in specific population, it is crucial integrate incidence cancer together careful consideration competing risks for cost-efficacy analysis. As example, patients decompensated liver cirrhosis candidates transplantation untreatable due function comorbidities, benefit detecting vanishes since dismal non-HCC-liver-related events (overdiagnosis) [2]. While future probably leans toward personalised approaches (i.e., integration new biomarkers, more sensitive techniques such as magnetic resonance [MR]), bi-annual abdominal ultrasound (US) without alpha-fetoprotein (AFP) [3] remains cornerstone current practice. Despite strong recommendation international guidelines [4-6], underused, this may depend on both physicians lower rates primary care doctors) (low adherence) issues [7, 8]. Therefore, training doctors key objective strategies aimed enhancing adherence. A variety have been explored, education physicians, nurse-led programmes, mailed outreach strategy, EMR-led best practice alerts [9-12]. The results are heterogeneous but can achieve interesting 53% up 80%–90% these should be confirmed large-scale populations, availability expert dedicated nurses encouraged. Finally, noted that widely opinion suggests US performed by extensive expertise US. study Brahmania et al. [13] Liver International, authors retrospective aiming evaluate impact region-wide automated recall program adherence Specifically, 2013 Calgary (Canada) diagnostic-image (DI) provider created protocol-based strategy based software used breast using mammography eligible screening. healthcare (gastroenterologist, hepatologist care) was allowed enrol submitting completed one-page requisition demographic characteristics, reason screening, presence absence cirrhosis. Patients underwent biannual US, if unreachable DI team twice, two different letters from patient physician were sent. aim retention rate instead HCC-related deaths. Here, acceptable defined least one within 1 year. If frankly congratulated putting place program, definition seems suboptimal. appropriate frequency indeed proven years ago every 6 months. 3-month interval does improve > cm, annual associated comparison interval. assessing legitimacy challenging. parallel, also worth noting adherence, well methods measure it, across literature. pragmatic approach might calculate number over theoretical determined timeframe. included total 7269 between 2022, most common aetiology hepatitis B virus (51%) only 37% had fact cases indication surprising cannot explained high proportion virus. Of whole cohort, 51.8% considered retained program. This seem pooled receiving adequate 24%, lowest USA (17.8%) highest Europe (43.2%) [8]. Nonetheless, none numbers comparable non-homogeneous studies. recent Spain revealed 84% known diagnosed under [14]. sense, note positive trend concerning detected previous around 47% [15]. after median follow-up 1.89 (IQR: 1.0–4.8), per year 1.82 1.15–2.08). relativised according short study. addition, same recognise some relevant limitations, lack prospectively recorded data AFP, response therapy viral aetiology, BMI, degree portal hypertension, HCC, overall survival. realm absolutely evolving field research reasons. First, change epidemiological landscape increase C virus-cured Steatotic Disease (SLD) (with alcohol) mandates assessment groups. information needed establish programs patients. When combined revisited life expectancy (negative depending groups), death, increased outcomes patients, mandate adjusting cut-offs indications surveillance. SLD higher cardiovascular extra-hepatic cancers, could dilute risk. Second, efficacy tools has questioned terms sensitivity. well-designed randomised clinical trial reported sensitivity alone 77% [16], suggesting when properly registered, technique bad all. available underused independently definition. remarked optimisation programmes faces several interrelated challenges: sustaining established target evaluating potential expansion SLD, appropriately selecting advanced diagnostics (biomarkers MR imaging), accurately identifying high-risk individuals, delivering approaches. Balancing demands while ensuring programme sustainability complex endeavour (Figure 1). awaiting development effective adjuvant [17, 18], continues method reducing mortality populations. Personalised individual hopeful wish future. meanwhile, "Make Most What We Have Today" all and/or utmost value. note, effective, their evaluations well. They consider proper population manner. Interpretation drafting manuscript (all authors); critical revision important intellectual content authors). All approve final version manuscript. Marco Sanduzzi-Zamparelli received speaker fees Bayer AstraZeneca travel grants Bayer, BTG, Eisai, Roche; Giuseppe Cabibbo participated advisory board Ipsen, AstraZeneca, MSD, Roche, Gilead. nothing report.
Language: Английский