Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma

Publication Date: May 22, 2023
Last Updated: June 1, 2023

EPIDEMIOLOGY AND PREVENTION

  • Public health policies and interventions should be implemented to address the significant mortality of HCC in the United States (Level 5, Strong Recommendation).
  • Vaccination for HBV infection should be given in all newborns as well as high-risk adults who failed to receive vaccination at birth to reduce the risk of HCC (Level 2, Strong Recommendation).
  • Antivirals should be given in all patients who meet criteria for treatment according to AASLD Guidance documents for HBV and HCV infection. In patients with chronic viral hepatitis, suppression of HBV and eradication of HCV infection decreases the risk of HCC development (Level 2, Strong Recommendation).
  • Patients with chronic liver disease should be counseled to maintain a healthy weight, have a balanced diet, avoid tobacco and alcohol, and achieve adequate control of comorbid conditions including components of the metabolic syndrome. A healthy lifestyle has multiple benefits and may decrease HCC risk (Level 3, Strong Recommendation).
  • Coffee consumption may be recommended for patients with chronic liver disease, as it has associated with decreased risk of HCC development (Level 5, Weak Recommendation, 12 of 15 agree).
    • There are insufficient data to recommend a specific dose, although studies suggest a dose–response curve.
  • AASLD does not advise use of other chemoprevention therapies such as statins, aspirin, and metformin solely to reduce HCC risk, despite some evidence of risk reduction (Level 5, Weak Recommendation).
    • In patients with other indications, these agents may be used in the setting of chronic liver disease (Level 3, Weak Recommendation).

SURVEILLANCE

  • Patients at high risk of developing HCC (see Table 1) should be entered into HCC surveillance programs, provided they would be candidates for HCC treatment (Level 2, Strong Recommendation).
    • Patients with Child-Turcotte-Pugh class C cirrhosis should not be enrolled in surveillance programs unless they are eligible for liver transplantation (Level 3, Strong Recommendation).
    • All patients listed for liver transplantation should undergo semiannual HCC surveillance because identification of early-stage HCC changes priority for transplantation (Level 3, Strong Recommendation).
    • AASLD recommends against HCC surveillance in patients with life-limiting comorbid conditions that cannot be remedied by liver transplantation or other directed therapies (Level 5, Strong Recommendation).
  • AASLD recommends against routine use of HCC surveillance in patients with HCV infection post-SVR with advanced fibrosis but without cirrhosis (Level 3, Weak Recommendation).
  • AASLD recommends against routine use of HCC surveillance in patients with NAFLD who have advanced fibrosis but without cirrhosis (Level 3, Weak Recommendation).
  • HCC surveillance should be performed using ultrasound and AFP at semiannual (approximately every 6 months) intervals (Level 2, Strong Recommendation).
    • AASLD recommends use of interventions such as best practice alerts or outreach programs to increase HCC surveillance adherence given the underuse of surveillance in clinical practice (Level 2, Strong Recommendation).
  • AASLD does not recommend routine use of CT- or MRI-based imaging and tumor biomarkers, outside of AFP, for HCC surveillance in at-risk patients with cirrhosis or chronic HBV (Level 5, Weak Recommendation).
    • Alternative imaging modalities, such as contrast-enhanced MRI, may be considered for HCC surveillance in select patients in whom US-based surveillance is suboptimal (Level 3, Weak Recommendation).

Overview

Title

Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma

Authoring Organization