More than 50,000 people are diagnosed with hepatocellular carcinoma (HCC) every year in Europe. Many cases are known to specialist liver centres years before they present with HCC. Despite this, HCC is usually detected at a late stage, when prognosis is very poor. For more than two decades, clinical guidelines have recommended uniform surveillance for all patients with cirrhosis. However, studies continue to show that this broad-based approach is inefficient and poorly implemented in practice. A “personalised” approach, where the surveillance regimen is customised to the needs of the patient, is gaining growing support in the clinical community. The cornerstone of personalised surveillance is the HCC risk model – a mathematical equation predicting a patient’s individualised probability of developing HCC within a specific time window. However, although numerous risk models have now been published, few are being used in routine care to inform HCC surveillance decisions. In this article, we discuss methodological issues stymieing the use of HCC risk models in routine practice - highlighting biases, evidence gaps and misconceptions that future research must address.

在欧洲，每年有超过 50,000 人被诊断患有肝细胞癌 (HCC)。许多病例在出现 HCC 前数年就已被专科肝脏中心了解。尽管如此，HCC 通常在晚期才被发现，此时预后非常差。二十多年来，临床指南建议对所有肝硬化患者进行统一监测。然而，研究继续表明，这种基础广泛的方法效率低下且在实践中实施不佳。根据患者需求定制监测方案的“个性化”方法正在获得临床界越来越多的支持。个性化监测的基石是 HCC 风险模型，这是一个数学方程，可预测患者在特定时间窗口内发生 HCC 的个体化概率。然而，尽管现已发布了许多风险模型，但很少有模型被用于常规护理中，为 HCC 监测决策提供信息。在本文中，我们讨论了阻碍 HCC 风险模型在日常实践中使用的方法论问题 - 强调了未来研究必须解决的偏见、证据差距和误解。