{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:52:45Z","timestamp":1789041165973,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["AMED JP25fk0210172"],"award-info":[{"award-number":["AMED JP25fk0210172"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JSPS KAKENHI Grant No. 22K15971."],"award-info":[{"award-number":["JSPS KAKENHI Grant No. 22K15971."]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study evaluated surveillance impact on outcomes in 1143 patients with first\u2010onset hepatocellular carcinoma (HCC) treated between 2003 and 2023, focusing on the etiological shift toward non\u2010B non\u2010C (NBNC) liver disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients were stratified by etiology: hepatitis B virus (HBV,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0182), hepatitis C virus (HCV,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0555), and NBNC (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0375). Surveillance was defined as \u2265 1 annual imaging examination. We assessed surveillance impact on overall survival (OS) using multivariable Cox regression analysis and analyzed diagnostic modalities and tumor markers stratified by etiology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over the 20\u2010year period, HCV\u2010related HCC decreased whereas NBNC\u2013\u2013HCC significantly increased, mainly driven by SLD. A total of 654 patients (58.8%) underwent regular surveillance. Compared with nonsurveilled patients, surveillance patients had significantly higher early\u2010stage diagnosis (79.8% vs. 36.9% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and curative treatment rates (52.8% vs. 21.6% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Multivariable analysis confirmed surveillance as an independent prognostic factor for OS (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01,085, hazard ratio: 0.61, and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Notably, in the NBNC group, nearly 60% of early\u2010stage cases were detected via CT\/MRI, significantly higher than in viral etiologies. Furthermore, des\u2010gamma\u2010carboxy prothrombin (DCP)\u2010only positivity was highest in patients with NBNC (22.4%), whereas AFP\u2010only positivity was rare (4.5%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although regular surveillance provides a robust survival benefit independent of liver function, a critical \u201csurveillance gap\u201d persists in the rapidly expanding NBNC population. The high reliance on CT\/MRI and DCP in NBNC patients suggests that standard ultrasound and AFP\u2010based strategies may have limitations in this group. Etiology\u2010specific protocols integrating cross\u2010sectional imaging and combined biomarkers warrant further consideration to bridge this gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hepr.70161","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T09:42:44Z","timestamp":1773826964000},"page":"1089-1100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Etiological Shifts and the Rising Burden of Non\u2013B Non\u2013C Hepatocellular Carcinoma on Surveillance and Prognosis: Insights From a 20\u2010Year Retrospective Observational Study"],"prefix":"10.1111","volume":"56","author":[{"given":"Yoko","family":"Yoshimaru","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Graduate School of Medical Sciences Kumamoto University  Kumamoto 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