Screening

AGA Releases Clinical Practice Update on Screening, Surveillance for HCC in NAFLD

The American Gastroenterological Association (AGA) has released a clinical practice update on the screening and surveillance for hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease (NAFLD). Included in the evidence-based review are recommendations and guidance that address 8 key clinical issues.

“The incidence of NAFLD-related HCC is increasing in the United States. Despite this rise in the

incidence, screening and surveillance for HCC among patients at risk of developing HCC is suboptimal in general, and is disproportionately lower in patients with NAFLD-related HCC,” the review authors wrote.

According to the authors, there is “a major unmet need” for best practice advice in the assessment of HCC among patients with NAFLD, as well as in screening and surveillance. To meet this need and to identify interventions that reduce HCC risk, the authors developed the following 8 best practice advice statements:

  1. Consider screening for HCC in all patients with cirrhosis due to NAFLD.
  2. Consider screening for HCC in patients with NAFLD with noninvasive markers that show evidence of advanced liver fibrosis or cirrhosis.
  3. Do not routinely consider HCC screening in patients with NAFLD in the absence of advanced liver fibrosis.
  4. Document the adequacy of ultrasonography in assessing the liver parenchyma for mass lesions when used for HCC screening in patients with cirrhosis due to NAFLD.
  5. Perform future screenings via computed tomography scan or magnetic resonance imaging scan—with or without α-fetoprotein—every 6 months when the quality of ultrasonography is suboptimal for screening of HCC.
  6. Counsel patients with cirrhosis due to NAFLD to abstain from drinking alcohol and smoking tobacco.
  7. Optimal management of diabetes and dyslipidemia through lifestyle modification and pharmacotherapy is encouraged in patients with NAFLD and advanced liver fibrosis who are at risk for HCC.
  8. Optimal management of obesity through lifestyle modification, pharmacotherapy, or endoscopic or surgical bariatric procedures is encouraged in patients with NAFLD and advanced liver fibrosis who are at risk for HCC. 

“NAFLD-associated liver complications are projected to become the leading indication for

liver transplantation in the next decade,” the review authors wrote. “Despite evidence that NAFLD-associated HCC may arise in the absence of cirrhosis, is often diagnosed at advanced stages, [and] is associated with lower receipt of curative therapy and with poorer survival, current society guidelines provide limited guidance/recommendations addressing HCC surveillance in patients with NAFLD outside the context of established cirrhosis.”

—Colleen Murphy

Reference:

Loomba R, Lim JK, Patton H, El-Serag HB. AGA clinical practice update on screening and surveillance for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: expert review [published online January 29, 2020]. Gastroenterology. doi:10.1053/j.gastro.2019.12.053.