Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia: summary of recommendations

Abstract

Introduction

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, the sixth most common cause of cancer death in Australia. With shifting aetiologies and a growing at-risk population, consistent routine surveillance recommendations are key to early detection of HCC and improved survival. We developed new evidence-based HCC surveillance guidelines for people at high risk in Australia due to liver disease and/or other risk factors. These guidelines were developed by a working group of experts in liver cancer control and included evidence reviews, synthesis and adaptation of existing guidelines for the Australian context, and predictive modelling.

Main recommendations

• This article summarises the recommendations and practice points for key population subgroups who were identified as potentially benefitting from routine HCC surveillance in the form of six-monthly ultrasound scans, with or without α-fetoprotein testing.
• People with liver cirrhosis and a non-HCC-related life expectancy of greater than six months are recommended to receive routine HCC surveillance.
• People with chronic hepatitis B virus infection who do not have liver cirrhosis are recommended to receive routine HCC surveillance if they have a family history of HCC, are Aboriginal or Torres Strait Islander peoples, or have an Asian, Pacific, or sub-Saharan African background, with varying start ages recommended for each group.
• People with stage 3 non-cirrhotic liver fibrosis (F3) may be recommended to receive routine HCC surveillance based on individual risk assessment, or otherwise monitored for progression to cirrhosis.

The final guidelines were approved by the National Health and Medical Research Council (NHMRC) in April 2023.

Changes in management as a result of the guideline

The updated guidelines formalise recommendations for people with cirrhosis, identify other patient groups who are recommended for surveillance, and highlight gaps in evidence where the benefit of surveillance is unclear. These guidelines were accompanied by the Roadmap to liver cancer control, a coordinated ten-year plan for advancing liver cancer prevention and early detection in Australia. The full guidelines can be accessed at https://cancer.org.au/clinical-guidelines/liver-cancer/hepatocellular-carcinoma.