Background/Objectives: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally, with prognosis and treatment outcomes that are significantly influenced by the stage at diagnosis. Early detection through regular surveillance is crucial for improving patient outcomes, especially in high-risk groups such as those with cirrhosis or chronic hepatitis B. Geographic variations in HCC risk factors, including viral hepatitis and non-alcoholic fatty liver disease (NAFLD), have led to the development of different international surveillance guidelines. This review aims to compare and evaluate the surveillance strategies proposed by the Asian Pacific Association for the Study of the Liver (APASL), the American Association for the Study of Liver Diseases (AASLD), and the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL–EORTC). Methods: The review examined and compared major international guidelines on HCC surveillance, focusing on patient selection, imaging modalities, and the integration of biomarkers. We also explored recent advancements in screening techniques, including artificial intelligence and emerging biomarkers, to identify future directions for improving surveillance strategies. Results: Our analysis identified key differences in the guidelines, particularly in imaging modality preferences and the use of biomarkers for early detection. While all guidelines place emphasis on high-risk populations, the inclusion criteria and surveillance intervals vary. Additionally, novel technologies such as artificial intelligence show potential to enhance the accuracy and efficiency of HCC detection. Conclusions: This review highlights the need to harmonize the international guidelines, particularly in regard to patients with non-cirrhotic NAFLD who remain under-represented in current surveillance protocols. Future research should focus on integrating emerging technologies and biomarkers to improve early detection and overall patient outcomes.
背景/目的：肝细胞癌是全球癌症相关死亡的主要原因，其预后和治疗效果在很大程度上受诊断时分期的影响。通过定期监测实现早期发现对改善患者预后至关重要，尤其对于肝硬化或慢性乙型肝炎等高危人群。由于病毒性肝炎和非酒精性脂肪性肝病等肝癌危险因素存在地域差异，国际上形成了不同的监测指南。本综述旨在比较和评估亚太肝脏研究协会、美国肝病研究协会以及欧洲肝脏研究协会与欧洲癌症治疗研究组织提出的肝癌监测策略。方法：本综述系统梳理并比较了国际主要肝癌监测指南，重点关注患者选择、影像学检查方式及生物标志物的整合应用。同时探讨了包括人工智能和新兴生物标志物在内的筛查技术最新进展，以明确优化监测策略的未来方向。结果：分析发现各指南存在显著差异，尤其在影像学检查方式偏好和早期检测生物标志物应用方面。虽然所有指南均强调高危人群监测，但纳入标准和监测间隔存在差异。此外，人工智能等新技术显示出提升肝癌检测准确性与效率的潜力。结论：本综述强调需要协调国际指南，特别是针对当前监测方案中代表性不足的非肝硬化非酒精性脂肪性肝病患者。未来研究应聚焦于整合新兴技术与生物标志物，以提升早期检测水平并改善患者总体预后。
Hepatocellular Carcinoma Surveillance Strategies: Major Guidelines and Screening Advances
肿瘤(癌症)患者之家