肝细胞癌 (HCC) 监测已被证明可以增加早期发现肿瘤的比例和接受治疗的机会，从而降低约 30% 的死亡率。目前的建议包括每半年进行一次腹部超声检查，伴或不伴血清 α -肝硬化患者和慢性病毒性肝炎人群特定亚群的胎儿蛋白测量。抗病毒疗法，例如有效抑制乙型肝炎病毒 (HBV) 复制的核苷酸类似物和能够消除超过 90% 患者的丙型肝炎病毒 (HCV) 的直接作用抗病毒药物，已经从根本上改变了病毒性肝病的结果，并降低（但并未消除）肝硬化和非肝硬化患者患 HCC 的风险。 HCC 风险是实施具有成本效益的监测的关键起点，也应指导有关其模式的决策过程。随着全球有效治疗的病毒患者数量持续增加，迫切需要确定哪些患者的监测获益/危害比有利，并确定如何对此类患者进行具有成本效益的筛查。本文讨论了这个主题，并试图根据成本效益原则和 HCC 风险随着时间的推移而下降的事实，确定哪些患者应该在 HBV 抑制或 HCV 根除后继续 HCC 监测。我们还制定了一项监测算法提案，将 HCC 监测的使用从“一刀切”的方法转变为基于肿瘤风险的个体化计划（精准监测）。© 2024 作者。由巴塞尔 S. Karger AG 出版。

Surveillance for hepatocellular carcinoma (HCC) has been proven to increase the proportion of tumors detected at early stages and the chance of receiving curative therapies, reducing mortality by about 30%.Current recommendations consist of a semi-annual abdominal ultrasound with or without serum alpha-fetoprotein measurement in patients with cirrhosis and specific subgroups of populations with chronic viral hepatitis. Antiviral therapies, such as nucleot(s)ide analogs that efficiently suppress the replication of hepatitis B virus (HBV) and direct-acting antiviral drugs able to eliminate the hepatitis C virus (HCV) in >90% of patients, have radically changed the outcomes of viral liver disease and decreased, but not eliminated, the risk of HCC in both cirrhotic and non-cirrhotic patients. HCC risk is a key starting point for implementing a cost-effective surveillance and should also guide the decision-making process concerning its modality. As the global number of effectively treated viral patients continues to rise, there is a pressing need to identify those for whom the benefit-to-harm ratio of surveillance is favorable and to determine how to conduct cost-effective screening on such patients.This article addresses this topic and attempts to determine which patients should continue HCC surveillance after HBV suppression or HCV eradication, based on cost-effectiveness principles and the fact that HCC risk declines over time. We also formulate a proposal for a surveillance algorithm that switches the use of surveillance for HCC from the "one-size-fits-all" approach to individualized programs based on oncologic risk (precision surveillance).© 2024 The Author(s). Published by S. Karger AG, Basel.