Table 1

Comparison of international HBV guidelines for HCC surveillance

EASL (2017)AASLD (2018)APASL (2015)
Who?

  • Suggests consideration of host and disease factors

  • Suggests risk scores (eg, PAGE-B) to stratify patients as low, moderate or high risk

  • Recommends surveillance for patients:

    • Undergoing long-term NA therapy

    • With cirrhosis

    • With moderate/high risk at onset of NA therapy

  • Recommends against surveillance for patients:

    • With low risk

  • Recommends surveillance for HBsAg+ patients with:

    • Cirrhosis

    • High risk (Asian/Black men >40 years, Asian women >50 years)

    • History of HCC in first degree relative

    • HDV coinfection

  • Affirms risk prediction scores can accurately risk stratify patients

  • Suggests threshold incidence of surveillance be determined individually based on the economic situation of each country

  • Recommends surveillance for patients with:

    • CHB at high risk

  • Recommends against surveillance for patients with:

    • Class C Child-Pugh scores.

How?Not stated

  • Recommends ultrasound±AFP 6 monthly

  • States insufficient evidence for/against inclusion of AFP in screening algorithms

  • Recommends USS+AFP 6 monthly, or preferably 3 monthly in cirrhotics and those at high risk

  • Recommends contrast-CT or contrast-MRI to confirm suspicious ultrasound lesions AND for initial screening of patients with advanced cirrhosis and high suspicion of HCC development

  • Recommends baseline contrast-CT or contrast-MRI obtained in all cirrhotics at presentation

  • AASLD, American Association for the Study of Liver Diseases; AFP, alpha fetoprotein; APASL, Asian Pacific Association for the Study of the Liver; CHB, chronic hepatitis B; EASL, European Association for the Study of the Liver; HBsAg+, hepatitis B surface antigen positive; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HDV, hepatitis D virus; NA, nucleos(t)ide analogue.