![]() Several previous studies have investigated HCC growth rates in order to determine the optimal surveillance or follow-up interval and reported several host factors that may affect the HCC growth rate, including sex, the doubling time of alpha-fetoprotein (AFP), and the presence of hepatitis B surface antigen (HBsAg). ![]() However, tumor growth in general is strongly affected by the microenvironment, 13 and HCC doubling time is likely affected by host factors as well as by tumor factors. 2 This recommendation is based on the assumption that the HCC growth rate is similar in every patient. 2, 11, 12 Currently, the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of Liver (EASL), and the Asian Pacific Association for the Study of the Liver (APASL) recommend that surveillance be conducted at 6-month intervals. 9, 10 While the ideal HCC surveillance interval is not known, intervals ranging from 3-12 months have been proposed. 8 The optimal surveillance interval is determined based on the tumor size and growth rate in order to detect HCCs at a stage when treatment is likely to produce a cure. Although complete consensus has yet to be reached on all three issues, the dilemmas faced by physicians caring for high-risk patients stem mainly from determining the optimal surveillance interval. The surveillance process involves determining at-risk populations (who should enter the surveillance program), the surveillance (diagnostic) test, and the surveillance interval (how frequently the tests should be done). 3, 4, 5 Hence, HCC surveillance is widely used and recommended for at-risk populations. 2 Furthermore, a randomized controlled study and a few uncontrolled studies have shown that HCC surveillance improves survival rates. 1 Small HCCs detected by routine surveillance can often be cured with a good prognosis (>50% 5-year disease-free survival rate), whereas HCCs detected after the onset of symptoms have a poor prognosis (≤10% 5-year survival rate). It has an identifiable latent period, which necessitates an effective routine surveillance program. Hepatocellular carcinoma (HCC) is an important public health problem.
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