The Malaysian Society of Gastroenterology and Hepatology Consensus Statements on Prevention and Early Detection of Hepatocellular Carcinoma in Malaysia.
Measured against the standard of care· AASLD 2023 Practice Guidance (Hepatology 78(6):1922-1965) / AGA Clinical Practice Update 2026 (Gastroenterology, Rich et al.) / BEACON-HCC consensus 2026 (Hepatology)
Decision at stakeSurveillance interval and modality: ultrasound plus serum AFP every 6 months for at-risk cirrhotic patients
Perform HCC surveillance with abdominal ultrasound PLUS serum AFP every ~6 months (semiannual, not annual) in adults with cirrhosis of any etiology who could benefit from HCC treatment: Child-Turcotte-Pugh A or B, and CTP C only if a liver-transplant candidate or listed. …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
Perform HCC surveillance with abdominal ultrasound PLUS serum AFP every ~6 months (semiannual, not annual) in adults with cirrhosis of any etiology who could benefit from HCC treatment: Child-Turcotte-Pugh A or B, and CTP C only if a liver-transplant candidate or listed. Do not surveil patients whose life expectancy is <1-2 years from comorbidity that neither transplantation nor HCC therapy can remedy, and weigh the physical, psychological and financial harms of surveillance case by case. Also surveil selected non-cirrhotic chronic HBV carriers: Asian men >40 and women >50 from endemic regions, people of African origin at younger ages, family history of HCC, or high viral load/active hepatitis. AGA 2026 endorses PAGE-B (intermediate/high risk at ≥10) and REAL-B to stratify these patients. Patients with HCV cirrhosis stay in surveillance after SVR. Patients without cirrhosis from other causes are NOT surveilled because incidence is too low (≤F3 fibrosis, MASLD without cirrhosis, HCV cured before cirrhosis), though fibrosis staging uncertainty warrants individual discussion. CT/MRI are not routine surveillance tools. Abbreviated MRI, GALAD and other blood biomarkers are investigational and should not replace ultrasound+AFP. Multicancer blood detection tests should not be used. Recall per AASLD 2023: AFP ≥20 ng/mL or a rising AFP (doubling, or a rise on two consecutive tests even below 20), any ultrasound observation ≥1 cm, or an inadequate ultrasound triggers multiphasic contrast CT or MRI read with LI-RADS. Treatment per AASLD 2023 is BCLC-linked: resection, ablation or transplant within Milan criteria for very-early/early disease, TACE and other locoregional therapy for intermediate disease, systemic therapy for advanced disease. Preferred first-line systemic therapy in Child-Pugh A is atezolizumab+bevacizumab or durvalumab+tremelimumab (STRIDE); sorafenib, lenvatinib or durvalumab monotherapy are the alternatives. BEACON-HCC (AASLD/HCC-LIVE, Hepatology 2026) is a Delphi consensus framework for treatment allocation that complements BCLC; it does not replace it. Under BEACON-HCC, macrovascular invasion does not automatically mean systemic therapy, and EBRT/SBRT and TARE are primary options. Continue post-treatment surveillance with contrast-enhanced cross-sectional imaging early after curative therapy.