Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 1;8(7):e2520294.
doi: 10.1001/jamanetworkopen.2025.20294.

Hepatocellular Carcinoma Surveillance and Survival in a Contemporary Asia-Pacific Cohort

Ryan Yanzhe Lim  1 , Benjamin Koh  1 , Cheng Han Ng  2   3 , Anand V Kulkarni  4 , Ken Liu  5   6 , Karn Wijarnpreecha  7   8 , Beom Kyung Kim  9   10 , Mark D Muthiah  1   2   11 , Sung Won Lee  12 , Ming-Hua Zheng  13 , Takumi Kawaguchi  3 , Hirokazu Takahashi  14   15 , Daniel Q Huang  1   2   11 ; Liver Cancer Research Network
Collaborators, Affiliations

Hepatocellular Carcinoma Surveillance and Survival in a Contemporary Asia-Pacific Cohort

Ryan Yanzhe Lim et al. JAMA Netw Open. .

Abstract

Importance: The etiologies of hepatocellular carcinoma (HCC) are changing. It is unclear whether the benefit of surveillance for people with HCC remains consistent given the changing etiologies of the disease.

Objective: To evaluate the association of HCC surveillance with the survival rates of a large contemporary cohort of people with HCC.

Design, setting, and participants: This was a retrospective cohort study that included participants with HCC between January 2008 and August 2023. Participants with HCC were identified from 5 international sites in Singapore, Japan, South Korea, and Australia. A total of 1185 adult participants were included in this cohort study. All included participants had available information regarding the presence or absence of surveillance. Data were analyzed from June 26, 2024, to March 6, 2025.

Main outcomes and measures: The primary outcome was overall survival rates with HCC surveillance vs no surveillance. Multivariable restricted mean survival time (RMST) analyses with lead-time bias adjustments were conducted to assess overall survival.

Results: Of 1185 participants with HCC, 921 (77.7%) were male, the mean (SD) age of the participants was 67.6 (10.7) years, and the mean (SD) body mass index was 25.7 (5.3). RMSTs were consistently higher for participants who underwent HCC surveillance (n = 975) (RMST difference at 1 year, 0.10 years [95% CI, 0.06-0.15 years]; P < .001; RMST difference at 3 years, 0.50 years [95% CI, 0.32-0.68 years]; P < .001; RMST difference at 5 years, 0.96 years [95% CI, 0.64-1.29 years]; P < .001) compared with participants who did not undergo surveillance (n = 210). RMSTs remained higher among participants with hepatitis B (HBV) or hepatitis C (HCV) who underwent surveillance compared with those with no surveillance across all follow-up periods. Among participants with metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease, there were no statistically significant differences in RMSTs in the first 3 years of follow-up between HCC surveillance and no surveillance.

Conclusions and relevance: This cohort study of 1185 participants with HCC found that HCC surveillance was associated with improved survival. This survival benefit was more prominent for people with HBV-associated and HCV-associated HCC. The survival benefit of surveillance was less consistent for people with MASLD-associated or alcohol-associated HCC, which may have been related to the relatively modest sample size in the nonviral groups.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ng is the CEO of LiverGENIX Pte Ltd. Dr Muthiah reported consulting fees from Roche, Astellas, and Gilead and paid speaking engagements for Boston Scientific, Olympus Medical, Roche, Astellas, Perspectum, and Echosens. Dr Kawaguchi reported lecture fees from ASKA Pharmaceutical Co, Ltd; Taisho Pharmaceutical Co, Ltd; Kowa Company, Ltd; Eisai Co, Ltd; EA Pharma Co, Ltd; Nippon Boehringer Ingelheim Co, Ltd; Sumitomo Pharma Co, Ltd; Novo Nordisk; Otsuka Pharmaceutical Co, Ltd; and Janssen Pharmaceutical outside the submitted work. Dr Huang reported serving on the advisory board for Gilead and Roche outside the submitted work. No other disclosures were reported. Dr Zheng has received honoraria for lectures from AstraZeneca, Hisky Medical Technologies Co Ltd, and Novo Nordisk Inc and consulting fees from Boehringer Ingelheim and serves as a consultant for Eieling Technology Ltd. Dr Zheng serves as an unpaid editorial board member of Hepatobiliary Surgery and Nutrition and Liver International. Dr Takahashi has received research grants from Astellas Pharma Inc, AbbVie GK, and Sysmex.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Curves of Overall Study Cohort Comparing Participants Who Underwent Hepatocellular Carcinoma Surveillance With Those Who Did Not
Figure 2.
Figure 2.. Kaplan-Meier Curves of Participants With Hepatitis B Virus–Associated Hepatocellular Carcinoma (HCC), Hepatitis C Virus–Associated HCC, Metabolic Dysfunction–Associated Steatotic Liver Disease–Associated HCC, and Alcohol-Associated HCC
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6. doi: 10.1038/s41572-020-00240-3 - DOI - PubMed
    1. Reveron-Thornton RF, Teng MLP, Lee EY, et al. Global and regional long-term survival following resection for HCC in the recent decade: a meta-analysis of 110 studies. Hepatol Commun. 2022;6(7):1813-1826. doi: 10.1002/hep4.1923 - DOI - PMC - PubMed
    1. Huang DQ, Singal AG, Kanwal F, et al. Hepatocellular carcinoma surveillance—utilization, barriers and the impact of changing aetiology. Nat Rev Gastroenterol Hepatol. 2023;20(12):797-809. doi: 10.1038/s41575-023-00818-8 - DOI - PubMed
    1. Huang DQ, Tran A, Tan EX, et al. Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients. Hepatobiliary Surg Nutr. 2022;11(6):848-860. doi: 10.21037/hbsn-21-419 - DOI - PMC - PubMed

Publication types

MeSH terms