Mino Masaaki, Kakazu Eiji, Kanto Tatsuya
Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Institute of Global Health and Medicine, Japan Institute for Health Security, Ichikawa, Japan.
Gut Liver. 2025 Sep 15;19(5):651-664. doi: 10.5009/gnl250187. Epub 2025 Sep 8.
Hepatitis C virus (HCV) clearance markedly reduces the risk of hepatocellular carcinoma (HCC); however, HCC continues to develop in a subset of patients, particularly in those with advanced fibrosis or cirrhosis. Leading hepatology societies, including Asian Pacific Association for the Study of the Liver, European Association for the Study of the Liver, American Association for the Study of Liver Diseases, Korean Association for the Study of the Liver, Taiwan Association for the Study of the Liver, and Japan Society of Hepatology, have issued divergent guidelines for HCC surveillance after sustained virologic response, which reflects variations in regional patient populations, healthcare infrastructure, and policy priorities. While traditional risk stratification primarily centers on histological staging of fibrosis, an array of additional host-related factors, including age, sex, alcohol use, metabolic comorbidities, and genetic and epigenetic profiles, further influence individual HCC risks. Recently developed predictive models aim to improve risk discrimination and inform tailored surveillance intervals. Concurrently, health economic analyses support the continuation of surveillance in high-risk populations. Nonetheless, the optimal surveillance frequency and criteria for patient selection remain matters of ongoing debates. This review synthesizes current controversies across international guidelines, presents an evaluation of the supporting evidence for varied surveillance strategies, highlights emerging tools for individualized risk assessment, and discusses cost-effectiveness considerations to inform personalized, evidence-based HCC surveillance in the post-HCV cure landscape.
丙型肝炎病毒（HCV）清除可显著降低肝细胞癌（HCC）的风险；然而，仍有一部分患者会继续发展为HCC，尤其是那些患有晚期纤维化或肝硬化的患者。包括亚太肝脏研究协会、欧洲肝脏研究协会、美国肝病研究协会、韩国肝脏研究协会、台湾肝脏研究协会和日本肝病学会在内的主要肝病学会，针对持续病毒学应答后的HCC监测发布了不同的指南，这反映了不同地区患者群体、医疗基础设施和政策重点的差异。虽然传统的风险分层主要集中在纤维化的组织学分期上，但一系列其他与宿主相关的因素，包括年龄、性别、饮酒情况、代谢合并症以及基因和表观遗传特征，会进一步影响个体的HCC风险。最近开发的预测模型旨在提高风险辨别能力，并为定制的监测间隔提供依据。同时，卫生经济学分析支持对高危人群继续进行监测。尽管如此，最佳监测频率和患者选择标准仍是持续争论的话题。本综述综合了国际指南中的当前争议，对各种监测策略的支持证据进行了评估，强调了新兴的个体化风险评估工具，并讨论了成本效益考量，以为丙型肝炎治愈后的个性化、基于证据的HCC监测提供参考。
