肝细胞癌 (HCC) 是少数 5 年生存率低于 20% 的癌症之一；然而，预后因诊断时的肿瘤分期而异。早期 HCC 患者的治愈性治疗选择可提供 5-10 年的中位生存期。因此，国际协会指南建议对高危患者（包括肝硬化或高危慢性乙型肝炎感染患者）每半年进行一次 HCC 监测。监测与早期 HCC 检测和治疗的增加相关，从而降低 HCC 相关死亡率。过去二十年来，腹部超声一直是 HCC 监测的基石，但最近的数据突显了其对早期 HCC 检测的敏感性欠佳，特别是对于肥胖患者和非病毒性肝病患者。超声联合甲胎蛋白 (AFP) 的组合对于早期 HCC 检测的敏感性比单独超声更高，尽管该组合仍会漏掉超过三分之一的早期 HCC。新兴的成像和基于血液的生物标志物策略在生物标志物第 2 期（病例对照）和第 3 期（队列）研究中获得了有希望的数据。除了超声波之外，磁共振成像 (MRI) 是研究最充分的成像策略，在队列研究中与超声波相比具有卓越的敏感性和特异性。人们提出了简化的 MRI 方案来解决有关 MRI 放射能力、成本和患者接受度的担忧。在生物标志物策略中，GALAD（包括性别、年龄、AFP、AFP-L3 和 DCP 的组合）是经过最好验证的，在一项国家多中心队列研究中对早期 HCC 检测具有良好的敏感性。液体活检生物标志物，包括甲基化 DNA 标志物，在病例对照研究中也显示出有希望的准确性。缩写 MRI 和 GALAD 目前正在进入前瞻性试验，以检查早期 HCC 检测和筛查相关危害等临床结果，这些是了解临床实践中采用的重要数据。随着更多监测策略的出现，将迎来一个精准监测时代，根据患者个体风险和预期测试性能定制最佳监测方式。© 2024 印度国家肝脏研究协会。由 Elsevier B.V 出版。保留所有权利，包括文本和数据挖掘、人工智能培训和类似技术的权利。

Hepatocellular carcinoma (HCC) is one of the few cancers with a 5-year survival that has remained below 20%; however, prognosis differs by tumor stage at diagnosis. Curative treatment options among patients with early-stage HCC afford a median survival of 5-10 years. Accordingly, international society guidelines recommend semi-annual HCC surveillance in at-risk patients, including those with cirrhosis or high-risk chronic hepatitis B infection. Surveillance is associated with increased early-stage HCC detection and curative treatments, leading to reduced HCC-related mortality. Abdominal ultrasound has been the cornerstone for HCC surveillance for the past two decades, but recent data have highlighted its suboptimal sensitivity for early-stage HCC detection, particularly in patients with obesity and those with non-viral etiologies of liver disease. The combination of ultrasound plus alpha fetoprotein (AFP) has higher sensitivity for early-stage HCC detection than ultrasound alone, although the combination still misses over one-third of HCC at an early stage. Emerging imaging and blood-based biomarker strategies have promising data in biomarker phase 2 (case-control) and phase 3 (cohort) studies. Beyond ultrasound, Magnetic resonance imaging (MRI) is the best-studied imaging strategy, with superior sensitivity and specificity compared to ultrasound in a cohort study. Abbreviated MRI protocols have been proposed to address concerns about MRI radiological capacity, costs, and patient acceptance. Of biomarker strategies, GALAD (a panel including gender, age, AFP, AFP-L3, and DCP) is the best validated, with promising sensitivity for early-stage HCC detection in a national multi-center cohort study. Liquid biopsy biomarkers, including methylated DNA markers, have also shown promising accuracy in case-control studies. Abbreviated MRI and GALAD are now entering prospective trials that examine clinical outcomes such as early-stage HCC detection and screening-related harms, which are essential data to understand for adoption in clinical practice. As additional surveillance strategies become available, it will allow an era of precision surveillance in which optimal surveillance modalities are tailored to individual patient risk and expected test performance.© 2024 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.