Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)

Jian Zhou, Huichuan Sun, Zheng Wang, Wenming Cong, Mengsu Zeng, Weiping Zhou, Ping Bie, Lianxin Liu, Tianfu Wen, Ming Kuang, Guohong Han, Zhiping Yan, Maoqiang Wang, Ruibao Liu, Ligong Lu, Zhenggang Ren, Zhaochong Zeng, Ping Liang, Changhong Liang, Min Chen, Fuhua Yan, Wenping Wang, Jinlin Hou, Yuan Ji, Jingping Yun, Xueli Bai, Dingfang Cai, Weixia Chen, Yongjun Chen, Wenwu Cheng, Shuqun Cheng, Chaoliu Dai, Wengzhi Guo, Yabing Guo, Baojin Hua, Xiaowu Huang, Weidong Jia, Qiu Li, Tao Li, Xun Li, Yaming Li, Yexiong Li, Jun Liang, Changquan Ling, Tianshu Liu, Xiufeng Liu, Shichun Lu, Guoyue Lv, Yilei Mao, Zhiqiang Meng, Tao Peng, Weixin Ren, Hongcheng Shi, Guoming Shi, Ming Shi, Tianqiang Song, Kaishan Tao, Jianhua Wang, Kui Wang, Lu Wang, Wentao Wang, Xiaoying Wang, Zhiming Wang, Bangde Xiang, Baocai Xing, Jianming Xu, Jiamei Yang, Jianyong Yang, Yefa Yang, Yunke Yang, Shenglong Ye, Zhenyu Yin, Yong Zeng, Bixiang Zhang, Boheng Zhang, Leida Zhang, Shuijun Zhang, Ti Zhang, Yanqiao Zhang, Ming Zhao, Yongfu Zhao, Honggang Zheng, Ledu Zhou, Jiye Zhu, Kangshun Zhu, Rong Liu, Yinghong Shi, Yongsheng Xiao, Lan Zhang, Chun Yang, Zhifeng Wu, Zhi Dai, Minshan Chen, Jianqiang Cai, Weilin Wang, Xiujun Cai, Qiang Li, Feng Shen, Shukui Qin, Gaojun Teng, Jiahong Dong, Jia Fan, Jian Zhou, Huichuan Sun, Zheng Wang, Wenming Cong, Mengsu Zeng, Weiping Zhou, Ping Bie, Lianxin Liu, Tianfu Wen, Ming Kuang, Guohong Han, Zhiping Yan, Maoqiang Wang, Ruibao Liu, Ligong Lu, Zhenggang Ren, Zhaochong Zeng, Ping Liang, Changhong Liang, Min Chen, Fuhua Yan, Wenping Wang, Jinlin Hou, Yuan Ji, Jingping Yun, Xueli Bai, Dingfang Cai, Weixia Chen, Yongjun Chen, Wenwu Cheng, Shuqun Cheng, Chaoliu Dai, Wengzhi Guo, Yabing Guo, Baojin Hua, Xiaowu Huang, Weidong Jia, Qiu Li, Tao Li, Xun Li, Yaming Li, Yexiong Li, Jun Liang, Changquan Ling, Tianshu Liu, Xiufeng Liu, Shichun Lu, Guoyue Lv, Yilei Mao, Zhiqiang Meng, Tao Peng, Weixin Ren, Hongcheng Shi, Guoming Shi, Ming Shi, Tianqiang Song, Kaishan Tao, Jianhua Wang, Kui Wang, Lu Wang, Wentao Wang, Xiaoying Wang, Zhiming Wang, Bangde Xiang, Baocai Xing, Jianming Xu, Jiamei Yang, Jianyong Yang, Yefa Yang, Yunke Yang, Shenglong Ye, Zhenyu Yin, Yong Zeng, Bixiang Zhang, Boheng Zhang, Leida Zhang, Shuijun Zhang, Ti Zhang, Yanqiao Zhang, Ming Zhao, Yongfu Zhao, Honggang Zheng, Ledu Zhou, Jiye Zhu, Kangshun Zhu, Rong Liu, Yinghong Shi, Yongsheng Xiao, Lan Zhang, Chun Yang, Zhifeng Wu, Zhi Dai, Minshan Chen, Jianqiang Cai, Weilin Wang, Xiujun Cai, Qiang Li, Feng Shen, Shukui Qin, Gaojun Teng, Jiahong Dong, Jia Fan

Abstract

Background: Primary liver cancer, of which around 75-85% is 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 in China in June 2017, which were updated by the National Health Commission in December 2019, additional high-quality evidence has emerged from researchers worldwide regarding the diagnosis, staging, and treatment of liver cancer, that requires the guidelines to be updated again. The new edition (2022 Edition) was written by more than 100 experts in the field of liver cancer in China, which not only reflects the real-world situation in China but also may reshape the nationwide diagnosis and treatment of liver cancer.

Key messages: The new guideline aims to encourage the implementation of evidence-based practice and improve the national average 5-year survival rate for patients with liver cancer, as proposed in the "Health China 2030 Blueprint."

Keywords: China; Diagnosis; Guidelines; Hepatocellular carcinoma; Primary liver cancer; Treatment.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2023 The Author(s). Published 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 indicators 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 presentation: significant enhancement of the lesion in the arterial phase (late major arterial phase), with decreased enhancement in the portal venous and/or delayed phases, in a “wash-in, wash-out” pattern. Atypical presentation: lack of lesion enhancement in the arterial phase or no or insignificant decrease in the enhancement during the portal venous and delayed phases, or even a slight increase in enhancement, etc. US, ultrasonography; MRI, multiparametric MRI; CT, dynamic contrast-enhanced CT scan; CEUS, contrast-enhanced ultrasonography, which uses ultrasound contrast to visualize the real-time blood perfusion in normal and diseased tissues. EOB-MRI: MRI scan enhanced with hepatocyte-specific contrast agent gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA). AFP (+): serum AFP test exceeding normal value.
Fig. 3.
Fig. 3.
Clinical staging and treatment pathway for HCC in China. Systemic antitumor therapy includes first-line and second-line therapy. First-line therapy: atezolizumab + bevacizumab, sintilimab + biosimilar of bevacizumab (BYVASDA®); donafenib, lenvatinib, sorafenib; FOLFOX4. Second-line therapy: regorafenib, apatinib, camrelizumab, tislelizumab

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Source: PubMed

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