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We read with great interest the recent article by Tseng et al evaluating hepatitis B surface antigen (HBsAg) levels as a marker for surveillance of hepatocellular carcinoma (HCC) in patients with inactive chronic hepatitis B (CHB).1 Leveraging large, long-term cohorts from multiple sources and propensity score matching, the study adds important evidence to the ongoing debate over whether certain subgroups of hepatitis B e-antigen (HBeAg)-negative patients with normal alanine transaminase (ALT) and low hepatitis B virus (HBV) DNA truly require continued HCC surveillance. The authors’ demonstration that patients with HBsAg <100 IU/mL have a negligible risk of HCC is clinically meaningful. However, we wish to highlight several implications and pose questions to guide future research and practice.