Prevention, surveillance, and early detection of hepatocellular carcinoma - a Brazilian multidisciplinary consensus.
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Coimbra Felipe José Fernández, Godoy André Luís de, Fernandes Paulo Henrique de Sousa, Castro Neto Heládio Feitosa E, Pinheiro Rodrigo Nascimento, Boin Ilka de Fátima Santana Ferreira, Andraus Wellington, Tustumi Francisco, Amaral Paulo Cezar Galvão do, Brandão-Mello Carlos Eduardo, Braun Alexcia Camila, Braghiroli Maria Ignez, Bredt Luis César, Caparroz Carla, Carrilho Flair José, Cunha Guilherme Moura, Diniz Alessandro Landskron, Forte Daniel Neves, Garcia José Huygens Parente, Genzini Tércio, Correia Mauro Monteiro, Oliveira Cássio Virgílio Cavalcante de, Kalil Antonio Nocchi, Lima Agnaldo Soares, Martins Guilherme Lopes Pinheiro, Rocha Cristina Melo, Menezes Marcos Roberto de, Motta-Leal-Filho Joaquim Maurício da, Murad Júnior Munir, Peixoto Renata D'Alpino, Pinheiro Rafael Soares Nunes, Rezende Marcelo Bruno de, Ribeiro Héber Salvador de Castro, Martins Mario Rino, Rocha Filho Duilio Reis da, Rosa Arthur Accioly, Szutan Luiz Arnaldo, Torres Orlando Jorge Martins, D'Albuquerque Luiz Augusto Carneiro, Mattos Ângelo Alves de, Coutinho Anelisa Kruschewsky, Herman Paulo, Oliveira Alexandre Ferreira
Аннотация
AIMS: To develop multidisciplinary evidence-based recommendations for the prevention and early detection of hepatocellular carcinoma.
METHODS: This consensus was coordinated by the Brazilian Society of Surgical Oncology, with the participation of 13 additional national societies. A steering committee defined the key clinical questions addressing prevention, surveillance, and early detection strategies. Recommendation statements were informed by a comprehensive, non-systematic review of the literature conducted using PubMed, Scopus, and the Cochrane Library.
RESULTS: Eighteen recommendations reached consensus, covering three main domains: 1. Primary prevention, including HBV vaccination, timely antiviral therapy for viral hepatitis, and lifestyle interventions for metabolic dysfunction. 2. Secondary prevention, outlining risk-based surveillance strategies for patients with advanced fibrosis or cirrhosis due to hepatitis B virus, hepatitis C virus, or metabolic dysfunction-associated steatotic liver disease. 3. Operational standards for surveillance, emphasizing ultrasound as the cornerstone of monitoring, the importance of structured reporting, management of small nodules, and the selective use of cross-sectional imaging.
CONCLUSIONS: These multidisciplinary recommendations provide practical, adaptable guidance for the prevention, surveillance, and early detection of hepatocellular carcinoma. This guidance document aims to reduce the burden of hepatocellular carcinoma and support better clinical outcomes across diverse healthcare settings.
CENTRAL MESSAGE: Prevention and early detection save lives in liver cancer. This Brazilian multidisciplinary consensus integrates the best scientific evidence and the expertise of specialists from across the country to more effectively guide the prevention, identification, and surveillance of hepatocellular carcinoma. By answering key clinical questions and offering practical, easy-to-use recommendations, this document helps physicians and healthcare teams provide better care to people at risk.
PERSPECTIVES: This consensus provides practical guidance to improve the prevention and early detection of liver cancer in daily clinical care. The recommendations emphasize raising awareness of hepatocellular carcinoma, stimulating the development of broader surveillance programs, promoting earlier diagnosis, and improving outcomes for patients at risk for developing primary liver cancer.