Introduction Hepatocellular carcinoma (HCC) is a leading cause of global cancer mortality, with China bearing a particularly high burden.1 The majority of HCC arises in the context of chronic liver disease and cirrhosis,2 primarily due to hepatitis B virus (HBV) infection. Consequently, HCC management requires a complex integration of tumor-directed therapy, treatment of the underlying liver disease, and preservation of hepatic function. In China, advances in HBV prevention are shifting HCC care toward a stronger anti-tumor focus, posing new challenges for healthcare systems. Historically, HCC diagnosis and treatment have included hepatobiliary surgery, interventional radiology, and oncology. The role of infectious disease (ID) physicians was largely confined to managing the underlying liver disease.3 However, the advent of targeted therapies and immune checkpoint inhibitors has transformed HCC treatment. While improving survival, these novel agents introduce unique complications, such as immune-related adverse events, including hepatic, which require hepatology expertise. Furthermore, the efficacy and tolerability of these systemic therapies are critically dependent on stable liver function.4 Therefore, the specialized knowledge of ID physicians in hepatology is increasingly vital for the comprehensive, longitudinal management of HCC patients.3 Neverthess, the specific role, engagement level, and challenges faced by ID physicians in China’s multidisciplinary HCC care framework remain poorly characterized. This cross-sectional survey aimed to delineate the current practices of ID physicians in HCC management, identify barriers to their expanded involvement, and provide an evidence base for future healthcare model optimization. 2. Research presentation The study protocol was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies, with the aim of clearly and transparently presenting the entire research process. Ethical approval (No. 2024-542) was granted by the Biomedical Ethics Committee of West China Hospital, Sichuan University. The study complied with the principles of the Declaration of Helsinki. Prior to participation, informed consent was obtained online, with the study’s purpose, procedures, and participants’ right to withdraw at any time being clearly explained. For this descriptive cross-sectional study, data were collected through an anonymous online questionnaire. The target participants were frontline physicians currently working in the ID departments of public hospitals in mainland China, who held the professional title of associate chief physician or higher and voluntarily participated in the survey. A convenience sampling method was employed. Data collection took place from November 9–20, 2025. Following expert review and pilot testing, the final questionnaire was structured into three domains: basic information (4 items); current clinical practices: 3 items (one multiple-choice question); and perceived challenges and future prospects: 3 items (two multiple-choice questions). Following rigorous quality control of 135 questionnaire responses, 122 valid cases were identified for analysis, yielding a response validity rate of 90.4%. Geographically, the 122 valid respondents were distributed as follows: East China, 31.15% (n = 38); North China, 20.49% (n = 25); South-Central China, 18.03% (n = 22); Southwest China, 16.39% (n = 20); Northwest China, 9.02% (n = 11); and Northeast China, 4.92% (n = 6). The vast majority of participants, 94.26% (n = 115), were affiliated with tertiary Grade A hospitals (Figure 1A). Concerning the total number of HCC patients seen annually by their departments, 37.70% (n = 46) reported managing more than 100 cases per year, 30.33% (n = 37) managed 50 to 100 cases, and 31.97% (n = 39) managed fewer than 50 cases (Figure 1B).Figure 1: Background characteristics of survey respondents (n = 122). (A) Distribution of hospital levels; (B) Annual hepatocellular carcinoma patient volume.Regarding their role in core anti-tumor treatment decision-making, 33.61% (n = 41) of ID physicians reported that their department routinely formulates treatment plans for targeted or immunotherapy regimens independently or takes a leading role, and 18.03% (n = 22) indicated that treatment plans are discussed jointly with hepatobiliary surgery or oncology departments before implementation. However, 39.34% (n = 48) reported that such regimens are primarily determined by surgery or oncology departments, with the ID department’s role limited to managing underlying liver disease, and 9.02% (n = 11) reported having no involvement in this process (Figure 2A).Figure 2: Current involvement of infectious disease physicians (n = 122). (A) Role in treatment plan formulation; (B) Role in routine clinical work.Concerning participation in multidisciplinary team (MDT) meetings, 34.43% (n = 42) of ID physicians were regular core MDT members, and 18.03% (n = 22) could frequently participate with substantive input. In contrast, 36.89% (n = 45) were only occasionally invited, and 10.66% (n = 13) rarely participated. Overall, 47.54% (n = 58) of respondents were not regularly integrated into the core HCC decision-making process (Figure 2B). Pertaining to routine clinical responsibilities, ID physicians reported the highest level of involvement in HCC screening and early diagnosis, with 96.72% (n = 118) participating. Substantial involvement was also reported in palliative supportive care for advanced patients (76.23%, n = 93), imaging evaluation and staging of HCC (73.77%, n = 90), monitoring and management of adverse events related to targeted/immunotherapy (65.57%, n = 80), and liver function maintenance after local treatment (62.30%, n = 76). Only 4.10% (n = 5) of respondents reported not routinely performing these tasks. When asked about the primary barriers to deeper engagement in comprehensive HCC management, the respondents identified several key factors. Traditional disciplinary boundaries were cited by 77.05% (n = 94), followed by a lack of systematic oncology training (70.49%, n = 86), and inadequate hospital policy or procedural support (54.92%, n = 67). Additional challenges included limited confidence due to inexperience in prescribing targeted/immunotherapy agents (40.98%, n = 50) and constraints on personal time and capacity (23.77%, n = 29). In terms of attitudes toward their future role, 73.77% (n = 90) considered it “highly necessary and an inevitable trend in specialty development” for ID physicians to assume a more substantive role in whole-course HCC management, while 22.95% (n = 28) regarded it as “necessary but requiring systematic training and institutional support.” Concerning training and support needs, specialized training in managing adverse events related to targeted and immunotherapy drugs was the most frequently requested, by 90.98% (n = 111) of respondents. This was followed by a need for platforms facilitating interdisciplinary communication with surgical and oncology colleagues (89.34%, n = 109), systematic updates on the latest HCC guidelines (88.52%, n = 108), and practical MDT case discussions focused on HCC (88.52%, n = 108). 3. Discussion This survey illuminates the transitional phase of ID physicians’ role in HCC management. They are moving beyond a supportive role confined to antiviral therapy, as evidenced by high involvement in screening (more than 96%) and substantial engagement in adverse event monitoring and palliative care (more than 60%). In the era of targeted/immunotherapy, in which liver function preservation and management of unique toxicities are critical,4 ID physicians serve as essential “gatekeepers of liver function and immune status.” However, a significant gap exists between this envisioned role and actual practice. ID physicians remain limited in core anti-tumor decision-making and MDT leadership, with only about one-third routinely leading treatment plans or serving as core MDT members. This gap stems from multiple, interrelated systemic barriers: entrenched disciplinary boundaries that view HCC as the exclusive domain of surgery/oncology; a knowledge gap due to lack of systematic oncology training, particularly regarding novel agents; and institutional policies (e.g., prescribing restrictions, underdeveloped MDTs) that lag behind clinical needs.5,6 Encouragingly, the ID community exhibits strong motivation for change, with over 96% supporting a greater future role. Their clearly articulated needs prioritizing adverse event management training, interdisciplinary platforms, and guideline updates provide a roadmap for facilitating this transition. Strategic entry points, such as leveraging their expertise in managing immunotherapy-related hepatotoxicity, could catalyze broader role integration. Limitations of this study include its cross-sectional design, which precludes causal inference; a convenience sample that, while geographically diverse, is skewed toward tertiary hospitals, limiting generalizability; the lack of data on certain institutional variables (e.g., hospital type); reliance on self-report; and a primarily descriptive analysis. In conclusion, ID physicians in China are poised to play a crucial yet underrealized role in comprehensive HCC care. They possess the foundational engagement and a strong willingness to evolve into whole-course managers. Realizing this potential requires concerted, multi-stakeholder efforts: 1) Targeted empowerment of ID physicians through structured oncology continuing education, focusing on systemic therapy and adverse event management; 2) institutional redesign to formally integrate ID into MDTs, remove policy barriers (e.g., prescribing rights), and incentivize their comprehensive care role; and 3) fostering a collaborative ecosystem led by academic societies to establish cross-specialty platforms and disseminate effective models of integrated care. By leveraging the unique hepatology and immunology expertise of ID physicians, China can advance toward a more patient-centered, deeply integrated paradigm for whole-course HCC management, ultimately improving patient outcomes. Acknowledgments We extend our sincere gratitude to all infectious disease physicians who participated in this survey despite their demanding clinical schedules. Funding None. Author Contributions Jiang-Nan Peng contributed to the conceptualization of the study, conducted formal analysis, and was involved in writing the original draft of the manuscript. Ya-Chao Tao contributed to the methodology development and performed formal analysis, and also played a key role in writing the original draft. Tao-You Zhou, Xue-Zhong Lei and En-Qiang Chen contributed to the conceptualization and methodology of the study, and En-Qiang Chen provided supervision and coordinated project administration. All authors provided valuable feedback during the writing-review & editing phase and approved the final manuscript. Conflicts of Interest None. Data Availability Statement The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Peng et al. (Mon,) studied this question.