S3-Leitlinie: Diagnostik und Therapie des hepatozellulären Karzinoms

Voesch, Sabrina; Bitzer, Michael; Albert, Jörg G.; Bartenstein, Peter; Wolf, Bechstein; Blödt, Susanne; Thomas, Brunner; Dombrowski, Frank; Eder, Matthias; Follmann, Markus; Christian, La Fougère; Paul, Freudenberger; Geier, A.; Gkika, Eleni; Götz, Martin; Hammes, E.; Helmberger, Thomas; Hoffmann, Ralf‐Thorsten; Wolf-Peter, Hofmann; Pe, Huppert; Achim, Kautz; Gabi, Konrad; Körber, Jürgen; Krug, David; Lammert, Frank; Lang, Hauke; Langer, Thomas; Lenz, Philipp; Mahnken, A.; Alexander, M. J.; Micke, Oliver; Nadalin, Silvio; Phúc, Nguyễn Hữu; Ockenga, J.; Oldhafer, KJ; Paprottka, Philipp M.; Paradies, Kerstin; Pereira, P. L.; Persigehl, Thorsten; Plauth, Mathias; Plentz, Ruben; Jürgen, Pohl; Riemer, Jutta; Reimer, P.; Graf, Johanna; Ritterbusch, Ulrike; Roeb, Elke; Schellhaas, Barbara; Stella, Péter; Schmid, Irene; Andreas, Schuler; Dietrich, von Schweinitz; Seehofer, Daniel; Sinn, Marianne; Stein, Alexander; Stengel, Andreas; Nadine, Steubesand; Scheffold, Christian; Tannapfel, Andrea; Taubert, Anne; Jörg, Trojan; Ingo, van Thiel; Reina, Tholen; Vogel, Arndt; Vogl, Thomas; Hilke, Vorwerk; Wacker, F; Waidmann, Oliver; Wedemeyer, Heiner; Wege, Henning; Wildner, Dane; Wittekind, Christian; Wörns, Marcus-Alexander; Peter, Galle; Nisar, Malek

doi:10.1055/a-1589-7568

Cited by 5 publications

(5 citation statements)

References 473 publications

(155 reference statements)

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“…Nevertheless, as new evidence emerges, liver biopsy seems to have an important role in diagnosis accuracy, identification of therapeutic targets, and prognosis [35]. The current German guidelines have precise indications for the performance of biopsies, favoring their implementation before the inclusion of patients in clinical trials, treatments with curative intent, or patients managed in a palliative manner, due to the therapeutic implications involved [36]. As more biopsies in the context of PLCs are obtained, the true incidence of cHCC-CCA can be estimated with greater certainty, as well as the inclusion of such patients in clinical trials, which, as in HCC, may improve their prognosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characterization of HCC/CCA Mixed Cancers in a Population-based Cohort

Teufel

Rodrı́guez

Winzler³

et al. 2023

JGLD

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Background and Aims: Primary liver cancer (PLC) ranks among of the most common cancers worldwide. Within this group, a minority of cases displays characteristics of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), known as combined hepatocellular cholangiocarcinoma (cHCC- CCA). Currently, there is no specific standardized therapy for these mixed tumors. Therefore, the aim of our study was to analyze the clinical course, treatment and outcome of cHCC-CCA patients in a European population-based registry. Methods: We investigated 9,144 patients with PLC (6,622 HCC, 2,356 iCCA, and 166 cHCC-CCA) diagnosed between 2009 and 2020. All data were obtained from Clinical Cancer Registry of Baden-Württemberg (BW), Germany. Results: In all three groups patients were predominantly male (82%, 57%, and 68% for HCC, iCCA and cHCC-CCA groups, respectively). 48% of cHCC-CCA patients were diagnosed as stage IV cancers, which was more than for HCC (31%) but less compared to CCA (64%). Overall median survival of cHCC-CCA patients was worse compared to HCC (9-13 months vs. 15.5 months, p<0.001) and rather comparable to CCA (11.8 months). Conclusions: Our data demonstrated that cHCC-CCA tumors appear to have a distinct clinical course with worse overall survival compared to HCC. Thus, identification of these cancers by histopathology is essential in order to further characterize this tumor entity and to provide accurate treatment to these patients.

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Section: Discussionmentioning

confidence: 99%

Clinical Characterization of HCC/CCA Mixed Cancers in a Population-based Cohort

Teufel

Rodrı́guez

Winzler³

et al. 2023

JGLD

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“…When diagnosed, NASH is considered a precancerous condition/lesion, implying that hepatocellular cancer (HCC) and, or less often, intrahepatic cholangiocarcinoma (iCCA; ratio: 5-7 HCC/1 iCCA) can develop and that surveillance should take place according to the corresponding S3 guideline [9][10][11][12]. The HCC incidence in NASH patients without liver cirrhosis is reported at 0.02 % per year and increases up to 1.5 % per year in the presence of liver cirrhosis [9].…”

Section: Commentarymentioning

confidence: 99%

“…Reference is made to the National S3 Guidelines on Hepatocellular [11,12]. US is a widely available, cost-effective, radiation-free method that allows assessment of hepatic steatosis.…”

Section: Commentarymentioning

confidence: 99%

“…Reference is made here to the National [11,12], the EASL-EASD-EASO Clinical Practice Guideline NAFLD [116] and current reviews [145]. Ultrasound (US) is a widely available, cost-effective and radiation-free method that allows the diagnosis of hepatic steatosis when the liver parenchyma shows increased echogenici- ty.…”

Section: Commentarymentioning

confidence: 99%

“…2). Patients with clear evidence of liver cirrhosis, diagnosed with non-invasive procedures, or confirmed advanced fibrosis/cirrhosis, diagnosed with liver biopsy, require regular monitoring for the development of liver-associated complications [11,12].…”

Section: Commentarymentioning

confidence: 99%

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Updated S2k Clinical Practice Guideline on Non-alcoholic Fatty Liver Disease (NAFLD) issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – April 2022 – AWMF Registration No.: 021–025

2022

Z Gastroenterol

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These Guidelines target all professional groups involved in the diagnosis and management of NAFLD: Internists, gastroenterologists, endocrinologists, diabetologists, obesity specialists, surgeons, clinical nutritionists, radiologists, specialists in pediatrics and adolescent medicine, pathologists, cardiologists, transplant physicians, patient representatives/advocacy groups as well as affected parties, family members and serves as information for benefits providers (health insurers, pension insurance funds). The German College of General Practitioners and Family Physicians (DEGAM) was invited to collaborate but declined to participate. Nevertheless, we deem these Guidelines to be equally relevant for general practitioners and family physicians.

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The application of high-performance ultrasound probes increases anatomic depiction in obese patients

Heinitz,

Müller,

Jenderka

et al. 2023

Sci Rep

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This study evaluated the impact of obesity on abdominal ultrasound diagnostics and assessed effect of high-performance ultrasound probes increased imaging quality. Lean and obese subjects (n = 40; 58% female) were categorized according to body mass index (BMI, 21 to 48 kg/m2). A highly standardized ultrasound examination of the abdomen was performed by trained examiners using three different probes in randomized order (standard probe versus two high-performance probes). Quality of B-mode and duplex ultrasound were assessed using a custom scoring approach for depiction of liver and kidney anatomy and vascularization. Across probes, imaging quality of hepatic and kidney anatomy was inversely related with BMI (P < 0.03, r < − 0.35). Age, sex, and BMI explained 51% of the variance within the ultrasound quality score, with β = − 0.35, P < 0.0001 for BMI. Compared to the standard probe, high-performance probes allowed for a better depiction of kidney and liver anatomy in subjects above BMI 35 kg/m2 (n = 20, all P < 0.05), resulting in a less pronounced deterioration of imaging quality with increased BMI (all P < 0.05). In conclusion the study shows that obesity impairs ultrasound imaging quality of abdominal anatomy. The application of high-performance probes can increase anatomic depiction in obese patients.Registration number of the German Registry of Clinical Studies: DRKS00023498.

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S3-Leitlinie: Diagnostik und Therapie des hepatozellulären Karzinoms

Cited by 5 publications

References 473 publications

Clinical Characterization of HCC/CCA Mixed Cancers in a Population-based Cohort

Clinical Characterization of HCC/CCA Mixed Cancers in a Population-based Cohort

Updated S2k Clinical Practice Guideline on Non-alcoholic Fatty Liver Disease (NAFLD) issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – April 2022 – AWMF Registration No.: 021–025

The application of high-performance ultrasound probes increases anatomic depiction in obese patients

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