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The Pearl study aims to recruit 3000 people with liver cirrhosis caused by one of the underlying conditions of HCV, HBV, alcohol-related, NAFLD and haemochromatosis, who have never been diagnosed with HCC. Participants will be recruited from 40 NHS sites throughout the UK and will be asked to attend at least 3 study visits. Thereafter they will be followed up via their medical history for up to 10 years using NHS digital. Pearl will collect blood, urine, clinical and imaging data at the study visits.

It is expected that during the four-year follow-up period around 100 Pearl patients will be diagnosed with HCC. Thus, the study’s aim is to assess whether specific technologies (including genetic, protein and other biomarkers as well as imaging markers) for the early detection of HCC as identified in the related SELiNa study, are able to detect liver cancer at the earliest stages when curative therapies may be applied and to develop new prediction models to identify patients at most at risk of developing HCC.