Role of Biomarkers and Biopsy in Hepatocellular Carcinoma

AFP is the oldest biomarker still in use for HCC detection and prognostication, and we support its use in HCC surveillance given the improvement in early detection sensitivity with AFP plus US over US alone. The GALAD score that combines AFP, AFP-L3, DCP, age, and sex may be an even more promising surveillance tool, although validation in larger phase 3 and 4 studies is still required. Recent research on sequencing HCC tumors has yielded substantial insights into HCC tumor biology and has raised the possibility of precision oncology in which therapy decisions are guided by cancer genetics. At this point, though, no mutational profile has been convincingly shown to predict response to HCC therapy. Given this, it has been believed that routine biopsy with sequencing of HCC is unlikely to change patient management in the short term. However, biopsy in a research setting to expand the understanding of HCC tumor genetics may assist in development of future, more effective systemic therapy for HCC.