Multidisciplinary Canadian consensus recommendations for the management and treatment of hepatocellular carcinoma

Abstract

Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, after lung and stomach cancer. The incidence of hcc in Canada is increasing and is expected to continue to increase over the next decade. Given the high mortality rate associated with hcc, steps are required to mitigate the impact of the disease. To address this challenging situation, a panel of 17 hcc experts, representing gastroenterologists, hepatologists, hepatobiliary surgeons, medical oncologists, pathologists, and radiologists from across Canada, convened to provide a framework that, using an evidence-based approach, will assist clinicians in optimizing the management and treatment of hcc. The recommendations, summarized here, were developed based on a rigorous methodology in a pre-specified process that was overseen by the steering committee. Specific topics were identified by the steering committee and delegated to a group of content experts within the expert panel, who then systematically reviewed the literature on that topic and drafted the related content and recommendations. The set of recommendations for each topic were reviewed and assigned a level of evidence and grade according to the levels of evidence set out by the Centre for Evidence-based Medicine, Oxford, United Kingdom. Agreement on the level of evidence for each recommendation was achieved by consensus. Consensus was defined as agreement by a two-thirds majority of the 17 members of the expert panel. Recommendations were subject to iterative review and modification by the expert panel until consensus could be achieved.

A Model to Identify Sarcopenia in Patients With Cirrhosis

“…Moreover, access to both CT and MRI is limited due to cost and availability 6 . Even recent guidelines take these considerations seriously as evidenced by recommending abdominal ultrasound over cross-sectional imaging for hepatocellular carcinoma monitoring 7,8 and suggesting that mid-thigh ultrasound may be more appropriate than standard anthropometrics for measuring lean body mass 9 .…”

Systematic review of guidelines for management of intermediate hepatocellular carcinoma using the Appraisal of Guidelines Research and Evaluation II instrument

“…Fifteen national organizations [17][18][19]21,22,[31][32][33][34][35] and 6 international groups [3,16,20,23,29,30] published these guidelines between 2003 and 2013. Two guidelines specifically covered TACE alone [22,23], while 19 covered HCC management more broadly.…”

“…The full text of the remaining 43 citations was assessed and 22 citations were excluded because they were not related to the management of HCC, were not clinical practice guidelines or consensus statements or were guidelines replaced by an updated version. Ultimately, 14 clinical practice guidelines [3,[16][17][18][19][20][21][22][23][24][25][26][27][28] and 7 consensus statements [29][30][31][32][33][34][35] were included. Sixteen of these documents were retrieved through searching medical databases [3,[16][17][18][19][21][22][23][24][25][26][27][28][29][30][31], the others through the search of guideline databases and professional society websites [20,[32][33][34][35].…”

Efficacy and Accessibility of a Novel Liver Fibrosis Evaluation Program

“…A significant advantage of this program is screening for possible hepatocellular carcinoma (HCC), which is particularly relevant for patients with hepatitis B or chronic hepatitis C with changes of fibrosis. In Canada and the United States, present guidelines recommend biyearly screening for HCC with sonography in patients with hepatitis B or frank cirrhosis of any cause (15,16).…”