The burden of hepatocellular carcinoma (HCC) is highest in East Asia and Africa, although its incidence and mortality are rapidly rising in the United States and Europe. With the implementation of hepatitis B vaccination and hepatitis C treatment programmes worldwide, the epidemiology of HCC is shifting away from a disease predominated by viral hepatitis - an increasing proportion of cases are now attributable to non-alcoholic steatohepatitis. Surveillance using ultrasound, with or without alpha-fetoprotein, every 6 months has been associated with improved early detection and improved overall survival; however, limitations in implementation lead to a high proportion of HCC being detected at late stages in clinical practice. Herein, we review the current state of HCC surveillance and highlight areas for future research, including improved risk stratification of at-risk patients, surveillance tools with higher sensitivity and specificity for early HCC, and interventions to increase surveillance utilisation.

中文翻译：

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肝细胞癌的流行病学和监测：新趋势

尽管肝细胞癌（HCC）的发病率和死亡率在美国和欧洲迅速上升，但东亚和非洲的肝细胞癌（HCC）负担最高。随着乙型肝炎疫苗接种和丙型肝炎治疗计划在全球范围内的实施，HCC的流行病学正在从以病毒性肝炎为主的疾病发生转变——现在越来越多的病例归因于非酒精性脂肪性肝炎。每 6 个月使用超声波进行监测（无论是否有甲胎蛋白）与改善早期发现和提高总体生存率有关；然而，实施方面的限制导致在临床实践中大部分 HCC 在晚期才被发现。在此，我们回顾了 HCC 监测的现状，并重点介绍了未来研究的领域，包括改进高危患者的风险分层、对早期 HCC 具有更高敏感性和特异性的监测工具，以及提高监测利用率的干预措施。