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

Jian Zhou, Huichuan Sun, Zheng Wang, Wenming Cong, Jianhua Wang, Mengsu Zeng, Weiping Zhou, Ping Bie, Lianxin Liu, Tianfu Wen, Guohong Han, Maoqiang Wang, Ruibao Liu, Ligong Lu, Zhengang Ren, Minshan Chen, Zhaochong Zeng, Ping Liang, Changhong Liang, Min Chen, Fuhua Yan, Wenping Wang, Yuan Ji, Jingping Yun, Dingfang Cai, Yongjun Chen, Wenwu Cheng, Shuqun Cheng, Chaoliu Dai, Wenzhi Guo, Baojin Hua, Xiaowu Huang, Weidong Jia, Yaming Li, Yexiong Li, Jun Liang, Tianshu Liu, Guoyue Lv, Yilei Mao, Tao Peng, Weixin Ren, Hongcheng Shi, Guoming Shi, Kaishan Tao, Wentao Wang, Xiaoying Wang, Zhiming Wang, Bangde Xiang, Baocai Xing, Jianming Xu, Jiamei Yang, Jianyong Yang, Yefa Yang, Yunke Yang, Shenglong Ye, Zhengyu Yin, Bixiang Zhang, Boheng Zhang, Leida Zhang, Shuijun Zhang, Ti Zhang, Yongfu Zhao, Honggang Zheng, Jiye Zhu, Kangshun Zhu, Rong Liu, Yinghong Shi, Yongsheng Xiao, Zhi Dai, Gaojun Teng, Jianqiang Cai, Weilin Wang, Xiujun Cai, Qiang Li, Feng Shen, Shukui Qin, Jiahong Dong, Jia Fan, Jian Zhou, Huichuan Sun, Zheng Wang, Wenming Cong, Jianhua Wang, Mengsu Zeng, Weiping Zhou, Ping Bie, Lianxin Liu, Tianfu Wen, Guohong Han, Maoqiang Wang, Ruibao Liu, Ligong Lu, Zhengang Ren, Minshan Chen, Zhaochong Zeng, Ping Liang, Changhong Liang, Min Chen, Fuhua Yan, Wenping Wang, Yuan Ji, Jingping Yun, Dingfang Cai, Yongjun Chen, Wenwu Cheng, Shuqun Cheng, Chaoliu Dai, Wenzhi Guo, Baojin Hua, Xiaowu Huang, Weidong Jia, Yaming Li, Yexiong Li, Jun Liang, Tianshu Liu, Guoyue Lv, Yilei Mao, Tao Peng, Weixin Ren, Hongcheng Shi, Guoming Shi, Kaishan Tao, Wentao Wang, Xiaoying Wang, Zhiming Wang, Bangde Xiang, Baocai Xing, Jianming Xu, Jiamei Yang, Jianyong Yang, Yefa Yang, Yunke Yang, Shenglong Ye, Zhengyu Yin, Bixiang Zhang, Boheng Zhang, Leida Zhang, Shuijun Zhang, Ti Zhang, Yongfu Zhao, Honggang Zheng, Jiye Zhu, Kangshun Zhu, Rong Liu, Yinghong Shi, Yongsheng Xiao, Zhi Dai, Gaojun Teng, Jianqiang Cai, Weilin Wang, Xiujun Cai, Qiang Li, Feng Shen, Shukui Qin, Jiahong Dong, Jia Fan

Abstract

Background: 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.

Summary: Since the publication of Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) 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 (2019 Edition) 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.

Key messages: 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.

Keywords: Cancer; Carcinoma; China; Diagnosis; Liver; Treatment.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Copyright © 2020 by S. Karger AG, Basel.

Figures

Fig. 1
Fig. 1
Schematic diagram of the recommended baseline specimen sampling protocol for liver tumors. A, B, C, and D denote the 12, 3, 6, and 9 o'clock positions, respectively, along the boundary between cancer and adjacent non-neoplastic liver tissue; E: tumor area; F: proximal non-neoplastic adjacent liver tissue; G: distal non-neoplastic adjacent liver tissue.
Fig. 2
Fig. 2
Pathway for the diagnosis of HCC. Typical characteristics: the “rapid in and rapid out” enhancement pattern that manifests as enhancement of lesions in the arterial phase and reduced enhancement in the portal venous or equilibrium phase of dynamic contrast-enhanced imaging. Atypical characteristics: absence of obvious enhancement of lesions in the arterial phase of dynamic contrast-enhanced imaging, or no reduction/no obvious reduction/mild increase in enhancement in the portal venous or equilibrium phase of dynamic contrast-enhanced imaging. MRI, dynamic contrast-enhanced MRI; CT, dynamic contrast-enhanced CT; CEUS, contrast-enhanced US. Ultrasound contrast agents are used for real-time observation of blood perfusion of normal and pathological tissues. EOB-MRI, contrast-enhanced MRI with the hepatocyte-specific contrast agent gadoxetic acid disodium (Gd-EOB-DTPA). AFP(+), serum AFP above the ULN; ULN, upper limit of normal; US, ultrasonography.
Fig. 3
Fig. 3
China clinical staging and treatment pathway for HCC. Notes: FOLFOX4, 5-fluorouracil, leucovorin, and oxaliplatin; HCC, hepatocellular carcinoma; PS, performance status; TACE, transarterial chemoembolization; UCSF, University of California, San Francisco.

Source: PubMed

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