Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Manual Proposed by the Japan Society of Hepatology

Kudo, Masatoshi; Okanoue, Takeshi

doi:10.1159/000111702

Cited by 300 publications

(355 citation statements)

References 51 publications

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“…4,7,8 In contrast, other studies found that the JIS scoring system was a better model in comparison with the CLIP and BCLC staging systems. 12,13,30 Several factors may contribute to these discrepancies. The characteristics of tumor-related variables, the relative score weighted for each variable, preferred treatment modality in different centers, the number of patients analyzed, the pattern of patient referral and the etiology of cirrhosis could all or in part influence the final results.…”

Section: Discussionmentioning

confidence: 99%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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BACKGROUND: Selecting an appropriate staging system is crucial to predict the outcome of patients with hepatocellular carcinoma (HCC). The optimal prognostic model for HCC is under intense debate. This study investigated the prognostic ability of the 5 currently used staging systems, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Japan Integrated Scoring (JIS) system, tumor-node-metastasis (TNM), and Tokyo score, for HCC. METHODS: Between 2002 and 2008, 1713 prospectively enrolled HCC patients were compared for their longterm survival by using the Akaike information criterion (AIC) according to the staging or scoring methods of these 5 models. RESULTS: The mean and median follow-up duration was 18 and 14 months, respectively. Among all patients, the CLIP staging system had the lowest AIC value in comparison with other systems in the Cox proportional hazards model, followed by the Tokyo score, JIS score, BCLC staging system, and TNM staging system. Patients undergoing curative treatment had a significantly better survival in comparison with patients undergoing noncurative treatment (P < .001). When the predictive accuracy of the staging systems was analyzed according to treatment strategy, the CLIP staging system had the lowest AIC value and remained the best prognostic model in patients undergoing curative (801 patients) and noncurative (912 patients) treatment. CONCLUSIONS: The CLIP staging system is the best long-term prognostic model for HCC in a cohort of patient with early to advanced stage of HCC. Its predictive accuracy is independent of the treatment strategy. Selecting an optimal staging system is helpful in improving the design of future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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“…Furthermore, imaging of 1-to 2-cm nodules would miss the diagnosis of HCC in up to 38% of cases. More recently, when hypovascular nodules are detected by MDCT and dynamic MRI, the guidelines published by the Japan Society of Hepatology recommend the use of Sonazoid-enhanced US and SPIOenhanced MRI [224]. When uptake by Kupffer cells is reduced in the Kupffer phase of SPIO-enhanced MRI, malignancy should be highly suspected [214,225,226].…”

Section: Ct Mri and Other Imaging Modalitiesmentioning

confidence: 99%

“…On the basis of the results of these studies, the guidelines published by the EASL [334] and the American Association for Study of Liver Diseases [335] recommend TACE as a first-line, noncurative therapy for nonsurgical patients with large/ multifocal HCC who do not have vascular invasion or extrahepatic spread (level I). In addition, according to the guidelines published by the Japan Society of Hepatology [224], hepatectomy or TACE is recommended if there are two or three tumors of less than 3-cm diameter, and TACE or hepatic arterial infusion chemotherapy is recommended if there are more than four tumors. In addition, TACE can be performed in patients at the early stage in whom RFA cannot be performed because of tumor location (proximity to a gallbladder, biliary tree, or blood vessel) or medical comorbidities [198].…”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…The new UCA Sonazoid provides Kupffer imaging, which is extremely stable and tolerable for multiple scanning at least up to 60 min in the post-vascular phase, and may further improve the detection rate of HCC with CEUS [41] . The analysis of Kupffer function provides essential information compared with other contrast agents [17,42] . CEUS with Sonazoid detects liver malignancy as defects on the sinusoidal phase with a high sensitivity of 95%, specificity of 93%, positive predictive value of 99%, and negative predictive value of 97% [43] .…”

Section: F E D C B Amentioning

confidence: 99%

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Wong

Xu²,

Xie³

2009

WJR

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Patients with liver cirrhosis are at increased risk of hepatocellular carcinoma (HCC). Conventional or baseline ultrasound (BUS) is often used as the first-line tool for HCC surveillance or detection, but the accuracy of BUS in HCC detection or differentiation from other focal liver lesions (FLLs) is limited. Contrast-enhanced ultrasound (CEUS) represents a recent revolution in the field of ultrasonography and it has become increasingly important in the detection and evaluation of FLLs. In CEUS, HCC typically exhibits arterial hyper-enhancement and portal-venous washout represented by hypoenhanced lesions in the portal venous and late phases. The detection rate of HCC was significantly higher with CEUS compared with BUS. Even regenerative or some dysplastic nodules may exhibit arterial hyperenhancement as they are differentiated from HCC by its iso-enhancing pattern in portal and late phases. The contrast-enhancement patterns of other different types of benign and malignant FLLs, as well as their detection rates with CEUS, were also discussed.

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Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Manual Proposed by the Japan Society of Hepatology

Cited by 300 publications

References 51 publications

Selecting an optimal staging system for hepatocellular carcinoma

Selecting an optimal staging system for hepatocellular carcinoma

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

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