Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

Masao Omata, Ann-Lii Cheng, Norihiro Kokudo, Masatoshi Kudo, Jeong Min Lee, Jidong Jia, Ryosuke Tateishi, Kwang-Hyub Han, Yoghesh K Chawla, Shuichiro Shiina, Wasim Jafri, Diana Alcantara Payawal, Takamasa Ohki, Sadahisa Ogasawara, Pei-Jer Chen, Cosmas Rinaldi A Lesmana, Laurentius A Lesmana, Rino A Gani, Shuntaro Obi, A Kadir Dokmeci, Shiv Kumar Sarin, Masao Omata, Ann-Lii Cheng, Norihiro Kokudo, Masatoshi Kudo, Jeong Min Lee, Jidong Jia, Ryosuke Tateishi, Kwang-Hyub Han, Yoghesh K Chawla, Shuichiro Shiina, Wasim Jafri, Diana Alcantara Payawal, Takamasa Ohki, Sadahisa Ogasawara, Pei-Jer Chen, Cosmas Rinaldi A Lesmana, Laurentius A Lesmana, Rino A Gani, Shuntaro Obi, A Kadir Dokmeci, Shiv Kumar Sarin

Abstract

There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia-Pacific region, where HCC is one of the leading public health problems. Since the "Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines" meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia-Pacific region, which has a diversity of medical environments.

Keywords: APASL; Asia–Pacific; Hepatocellular carcinoma; Treatment algorithm.

Conflict of interest statement

Masao Omata received fees for being a speaker, consultant, and advisory board member from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Otsuka, Astellas, Gilead Sciences, Chugai, Mitsubishi Tanabe, Kyorin, Merck Sharp and Dohme, Dainippon Sumitomo, Vertex Pharmaceuticals, Takeda, Merck Serono, and Zeria. Ann-Lii Cheng received consultant fees from Novartis, Merck Serono, Eisai, Merck Sharp and Dohme, ONXEO, Bayer, Bristol-Myers Squibb, and Ono Pharmaceutical. Norihiro Kokudo received research grants from Dainippon Sumitomo, Astellas, and Taiho. Masatoshi Kudo received lecture fees from Bayer, Eisai, Merck Sharp and Dohme, and Ajinomoto, research grants from Chugai, Otsuka, Takeda, Dainippon Sumitomo, Daiichi Sankyo, Merck Sharp and Dohme, Eisai, Bayer, and AbbVie, and consulting or advisory fees from Kowa, Merck Sharp and Dohme, Bristol-Myers Squibb, Bayer, Chugai, and Taiho. Jidong Jia received consultation and speaker fees from Bristol-Myers Squibb, Gilead, Merck Sharp and Dohme, Novartis, and Roche. Sadahisa Ogasawara received a consulting or advisory fee from Bayer and Eisai and honoraria from Bayer and Eisai. Jeong Min Lee, Ryosuke Tateishi, Kwang-Hyub Han, Yoghesh K. Chawla, Shuichiro Shiina, Wasim Jafri, Diana Alcantara Payawal, Takamasa Ohki, Pei-Jer Chen, Cosmas Rinaldi A. Lesmana, Laurentius A. Lesmana, Rino A. Gani, Shuntaro Obi, A. Kadir Dokmeci, and Shiv Kumar Sarin declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Diagnostic algorithm for hepatocellular carcinoma using multiple modalities (a) and only dynamic CT/MRI (b) (APASL 2016). *Cavernous hemangioma sometimes shows hypointensity on the equilibrium (transitional) phase of dynamic Gd-EOB-DTPA MRI (pseudo-wash-out). It should be excluded by further MRI sequences and/or other imaging modalities. †Cavernous hemangioma usually shows hypointensity on the hepatobiliary phase of Gd-EOB-DTPA MRI. It should be excluded by other MRI sequences and/or other imaging modalities
Fig. 2
Fig. 2
Treatment algorithm for hepatocellular carcinoma (APASL 2016). *Decisions regarding resectability should be discussed in a multidisciplinary team. †RFA is recommended as the first choice for the local ablation. ‡Currently, sorafenib and regorafenib are drugs that have shown clinical benefits in phase III studies. See text for use of systemic therapy. §Liver transplantation is recommended when indicated. ||Local ablation is an alternative treatment in resectable patients (≤3 cm and ≤3 nodules). Choice of treatments should be discussed in a multidisciplinary team. ¶TACE is an alternative treatment in patients with macrovascular invasion (no extrahepatic metastasis). Choice of treatments should be discussed in a multidisciplinary team. **Treatment conversion from TACE to systemic therapy is recommended for patients in whom TACE is expected to be ineffective

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