The Impact of HCC Surveillance on Tumor Features and Receipt of Curative Therapy: A Focus on Chronic Hepatitis B and MASLD.

BACKGROUND: As hepatocellular carcinoma (HCC) etiologies shift from viral to non-viral, many at-risk patients lack surveillance in real-world practice. This study characterizes the clinical features and receipt of curative therapy in HCC patients with and without surveillance. METHODS: A retrospective cohort study was conducted at National Taiwan University Hospital (2015-2025). Patients newly diagnosed with HCC who had not undergone regular surveillance (n = 50) were compared with a consecutive surveillance-diagnosed cohort (n = 100). Subgroup analyses were performed in patients with chronic hepatitis B and MASLD. RESULTS: Compared with the surveillance group, non-surveillance patients had higher baseline liver enzymes and alpha-fetoprotein levels, larger tumors, higher rates of multifocal tumors, and more frequent vascular invasion. Symptomatically diagnosed non-surveillance patients also presented with more advanced disease. Multivariable analysis identified surveillance as a strong independent predictor of receiving curative therapy (odds ratio [OR]: 17.78; 95% confidence interval [CI]: 5.56-56.88, p < 0.001). In the chronic hepatitis B subgroup, both surveillance (OR 26.79, 95% CI: 6.80-106.00, p < 0.001) and higher BMI (OR 1.18, 95% CI: 1.05-1.33, p = 0.005) were independent predictors of curative therapy. The rate of HBV carriers (72%), cirrhosis (54%), and MASLD (14%) remained substantial within the non-surveillance group. CONCLUSION: HCC surveillance was associated with earlier stage at diagnosis and independently predicted receipt of curative therapy; higher BMI was an additional predictor in the HBV subgroup. Most patients diagnosed without surveillance had underlying HBV infection, cirrhosis or MASLD, and presented with more advanced disease and lower rates of curative therapy.