Hepatitis B Virus and Hepatocellular Carcinoma: Risk-Based Surveillance Strategies

Purpose of review We aim to evaluate the efficacy of risk-based surveillance strategies for hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) patients, addressing key questions: How can risk stratification enhance early detection? What are cost-effective approaches across diverse settings? How may novel diagnostic tools enhance surveillance? Recent findings Recent studies highlight a persistent risk of HCC despite antiviral therapy, with reported annual incidences of 0.01–5.4% depending on cirrhosis status. Validated scores (e.g., PAGE-B, mPAGE-B, REAL-B) improve risk stratification, while liver stiffness measurement (LSM) and biomarkers, such as GALAD, enhance detection sensitivity, ranging from 54% to 91%. Economic analyses support cost-effectiveness when annual HCC risk ≥ 0.2%, with ultrasound ± AFP as the surveillance backbone. Advanced modalities like CT/MRI and liquid biopsies have shown promise, while AI-driven models and virologic markers (e.g., HBcrAg) are emerging as dynamic predictors. Summary Risk-based surveillance, guided by scores and LSM, effectively targets high-risk HBV patients, reducing mortality and optimizing resources. These emerging tools hold promise for earlier detection, but validation and cost-effectiveness require further research. This approach will impact future studies by prioritizing personalized, globally adaptable strategies to achieve HBV elimination goals.