Net benefit of surveillance varies by hepatocellular carcinoma risk in patients with cirrhosis

NCT02582918 IMPACT AND IMPLICATIONS: Surveillance is recommended in all patients with cirrhosis, although its net benefit may differ between patients based on risk of HCC. Using 3 validated clinical risk scores in 2142 patients with cirrhosis followed for a median of 36 months, we found HCC incidence significantly increased from low- to high-risk categories, whereas surveillance-related harms were similar across all risk strata. Therefore, the net benefit of HCC surveillance was greatest for high-risk individuals and lowest for low-risk stratum. These data provide an impetus to transition from one-size-fits-all surveillance to a risk-stratified or precision approach.