Guideline for stratified screening and surveillance in patients with high risk of primary liver cancer (2020)

Abstract

The age-adjusted incidence of primary liver cancer (PLC) has been declining in China. However, PLC cases in China account for 55% globally. The disease burden is still high and the five-year survival rate has not improved significantly in the past two decades. This guideline outlines PLC screening in populations with high risk, both in the hospital and community settings. Liver cirrhosis and chronic hepatitis B are the main causes of PLC in China. For better PLC surveillance and screening in clinical practices, it is recommended that these populations be stratified into four risk levels, namely, low-, intermediate-, high-, and extremely high-risk. A lifelong surveillance is suggested for those with risks of PLC. The intervals and tools for surveillance and screening are recommended based on risk levels. Abdominal ultrasonography combined with serum alpha-fetoprotein tests (routine surveillance) is recommended every 6 months for high risk PLC. Routine surveillance every 3 months and enhanced CT/MRI examinations every 6-12 months is recommended for those with extremely high risk of PLC. The surveillance interval can be extended to one year or longer for those with low or intermediate risk because the annual incidence of low risk PLC is relatively low. The cost-effectiveness of these recommendations remains to be evaluated.