Toward personalized hepatocellular carcinoma surveillance: A risk-stratified approach

Hepatocellular carcinoma (HCC) surveillance enables early tumor detection, expanding eligibility for curative treatment.Current guidelines involve semiannual ultrasound with or without alpha-fetoprotein for at-risk populations.However, patients with chronic liver disease vary widely in HCC risk depending on disease etiology, fibrosis stage, comorbidities, and individual patient characteristics.Therefore, a conventional "one-size-fits-all" strategy may yield suboptimal outcomes.Recent advances support a shift toward personalized HCC surveillance driven by risk stratification and tailored surveillance modalities.Several clinical prediction models, including PAGE-B, aMAP, and PLEASE scores, may assist in stratifying patients by risk.In addition, emerging blood-based biomarkers and algorithms such as GALAD, GAAD and liquid biopsy demonstrate potentially improved performance for early-stage HCC detection.Imaging innovations, particularly abbreviated magnetic resonance imaging, may offer improved diagnostic accuracy in high-risk populations.However, robust data demonstrating surveillance-related survival benefits are still lacking.A personalized surveillance strategy aligns testing intensity and modality with individual patient risk, optimizing early detection while minimizing unnecessary procedures, costs, and surveillanceassociated harms.Future prospective studies are needed to validate personalized pathways and facilitate their implementation in routine practice.This narrative review summarizes the current evidence on risk stratification and emerging modalities to support a personalized HCC surveillance strategy.