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

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.