Prospective Evaluation of Hepatocellular Carcinoma Surveillance in At-Risk Patients (Screening HCC)

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and remains a leading cause of cancer-related mortality worldwide. Early detection through surveillance is associated with improved access to curative therapies and better survival outcomes. Despite international guideline recommendations, implementation of surveillance programs remains heterogeneous in routine clinical practice, and limited real-world evidence is available regarding the effectiveness of structured HCC surveillance pathways in Brazil.

This prospective multicenter observational study is designed to evaluate the performance of a structured HCC surveillance program implemented within the Rede D'Or healthcare network. The program combines standardized abdominal ultrasound reporting using the Ultrasound Liver Imaging Reporting and Data System (US LI-RADS), regular alpha-fetoprotein (AFP) assessment, dedicated training of healthcare professionals, and predefined referral pathways for diagnostic evaluation and clinical management.

The study aims to generate real-world evidence regarding the effectiveness of standardized surveillance strategies in populations at increased risk for HCC. In addition to evaluating HCC detection, the study will assess the clinical characteristics and staging patterns of diagnosed tumors, detection of other malignant liver lesions, and the efficiency of the diagnostic and treatment pathway. Special attention will be given to patients who do not fully meet traditional surveillance criteria but may still present clinically relevant risk for HCC, including individuals with advanced fibrosis and metabolic dysfunction-associated steatotic liver disease (MASLD).

No experimental interventions will be administered as part of this protocol. All surveillance procedures, diagnostic investigations, and treatment decisions will be performed according to routine clinical practice and the judgment of treating physicians. Data generated during routine care will be collected prospectively and analyzed to better understand the effectiveness of structured surveillance programs in real-world clinical settings.

Inclusion criteria

• Written informed consent.
• Age 18 years or older.
• Liver cirrhosis of any etiology.
• Chronic hepatitis B with moderate or high risk of HCC according to PAGE-B criteria.
• Non-cirrhotic chronic liver disease with increased risk for HCC, including fibrosis stage 3 or higher or metabolic dysfunction-associated steatotic liver disease (MASLD) with one or more risk factors for HCC.
• Followed at hepatology clinics within the Rede D'Or health network.
• Eligible for routine HCC surveillance with ultrasound and alpha-fetoprotein according to standard clinical practice.

Exclusion criteria

• Known hepatocellular carcinoma at enrollment.
• Previous diagnosis of hepatocellular carcinoma.
• Metastatic liver disease.
• Other malignant liver tumors present at enrollment.
• Clinical condition preventing routine surveillance follow-up.
• Inability to provide informed consent.