We read with great interest the study by Hirode et al1 regarding the utility of adding serum biomarkers (BMs) to ultrasound (US) for hepatocellular carcinoma (HCC) surveillance in high-risk patients. The authors are to be commended for conducting this well-designed randomized controlled trial, which represents an important and timely step toward optimizing HCC surveillance strategies. They demonstrated that the addition of α-fetoprotein (AFP), lectin-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP) to biannual US did not significantly improve the detection of early-stage HCC compared with US alone, which is pivotal as it challenges the routine incorporation of these BMs in general surveillance protocols.
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