Review Article: Cancer Surveillance for Early Detection of Liver Cancer in Patients with HBV Infection

BACKGROUND AND AIMS: Chronic hepatitis B virus (HBV) infection remains a major cause of hepatocellular carcinoma (HCC). Although antiviral therapy reduces cirrhosis and liver failure, HCC may still develop in patients with HBV, including in non-cirrhotic livers. This review aimed to evaluate current HCC surveillance strategies in HBV infection, focusing on risk stratification and advances in early detection. METHODS: English-language literature published in PubMed and the Cochrane Database was comprehensively reviewed. This narrative review assessed the effectiveness of HCC surveillance strategies in HBV-infected patients, with emphasis on recent advances in early-stage HCC detection. RESULTS: This review summarizes viral, host and environmental factors associated with HCC susceptibility and evaluates current surveillance using ultrasound with or without alpha-fetoprotein (AFP). Surveillance eligibility should follow guideline-defined risk criteria: patients with an estimated annual HCC risk below 0.2% generally do not require routine surveillance and should undergo periodic risk reassessment, whereas patients meeting surveillance criteria should undergo ultrasound with or without AFP every 6 months. Risk-prediction scores can refine assessment but should be distinguished from early-detection tests. GALAD, HES 2.0, multi-target blood tests, and abbreviated magnetic resonance imaging are promising early-detection approaches, but much of the supporting evidence derives from mixed-aetiology or non-HBV cohorts and prospective HBV-specific validation remains limited. CONCLUSION: A risk-adapted approach should separate estimation of future HCC risk from surveillance and early-detection testing. Guideline-eligible patients should undergo surveillance every 6 months, while emerging biomarker, imaging and artificial-intelligence approaches remain adjunctive or investigational pending further HBV-specific validation.