Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)

Abstract

<b><i>Background:</i></b> Primary liver cancer, around 90% are hepatocellular carcinoma in China, is the fourth most common malignancy and the second leading cause of tumor-related death, thereby posing a significant threat to the life and health of the Chinese people. <b><i>Summary:</i></b> Since the publication of <i>Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition)</i> in 2018, additional high-quality evidence has emerged with relevance to the diagnosis, staging, and treatment of liver cancer in and outside China that requires the guidelines to be updated. The new edition <i>(2019 Edition)</i> was written by more than 70 experts in the field of liver cancer in China. They reflect the real-world situation in China regarding diagnosing and treating liver cancer in recent years. <b><i>Key Messages:</i></b> Most importantly, the new guidelines were endorsed and promulgated by the Bureau of Medical Administration of the National Health Commission of the People’s Republic of China in December 2019.

Overview of Prognostic Systems for Hepatocellular Carcinoma and ITA.LI.CA External Validation of MESH and CNLC Classifications

“…It has several similarities with the BCLC system, but it supports more aggressive treatment options for advanced HCC stages. For example, the CNCL system indicates liver resection in patients belonging to Ia, Ib, and IIa categories, that correspond to the BCLC B stage with 2–3 nodules >3 cm, and also for select patients classified in IIb and IIIa stage (multinodular and locally advanced HCC) [ 9 , 10 , 11 ]. The updated 2019 CNCL version [ 11 ] is reported in the Table 3 .…”

“…This database, due to its heterogeneity in terms of tumour stage, underlying liver disease severity, and therapeutic approaches, provides a reliable insight into the characteristics of HCC in a European/North American population and, therefore, it represents an optimal substrate for the external validation of the new MESH [ 8 ] and CNLC [ 9 , 10 , 11 ] scores in real-life clinical practice.…”

“…Baseline characteristics of the study cohort are described in the Supplementary Table S1 . Enrolled patients were classified according to ITA.LI.CA prognostic score [ 12 ], ITA.LI.CA simplified staging [ 35 ], CLIP [ 14 ] and MESH [ 8 ] scores, and BCLC [ 15 ] and CNCL [ 9 , 10 , 11 ] staging systems ( Supplementary Table S2 ).…”

“…Third, in order to concretely apply the comparison rules previously described to the need of clinical practice, we have performed a formal comparison between the most recent prognostic systems proposed for each of the above mentioned three categories, using a large Italian database. In particular, we have compared the Taiwanese Model to Estimate Survival for HCC (MESH) [ 8 ] score for the prognostic scores category, the Chinese Liver Cancer (CNLC) classification [ 9 , 10 , 11 ] for the staging systems category, and the Italian Liver Cancer (ITA.LI.CA) prognostic score and staging system [ 12 ] for the combined prognostic systems category. The Cancer of the Liver Italian Program score [ 13 , 14 ] and the Barcelona Clinic Liver Cancer (BCLC) classification [ 15 ] are also taken as reference for the prognostic scores and the staging systems categories, respectively.…”

Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration

“…Imaging-guided ablative therapies have become fundamental in the treatment of hepatocellular carcinoma (HCC), and have proven to be competitive with surgery in terms of overall survival in cases of single nodules less than 2 cm [ 1 , 2 , 3 , 4 ]. However, higher local recurrences have been demonstrated in HCC patients treated with percutaneous ablation therapy [ 5 , 6 , 7 , 8 , 9 ], reaching higher than 40% during 2–3 years of follow-up [ 10 , 11 ]. It is well known that the local tumor progression (LTP) rate differs markedly depending on whether or not a 5 mm ablative margin is secured [ 12 ].…”