Clinical guideline SEOM: hepatocellular carcinoma

J Sastre, R Díaz-Beveridge, J García-Foncillas, R Guardeño, C López, R Pazo, N Rodriguez-Salas, M Salgado, A Salud, J Feliu, J Sastre, R Díaz-Beveridge, J García-Foncillas, R Guardeño, C López, R Pazo, N Rodriguez-Salas, M Salgado, A Salud, J Feliu

Abstract

Hepatocellular carcinoma (HCC) represents the second leading cause of cancer-related death worldwide. Surveillance with abdominal ultrasound every 6 months should be offered to patients with a high risk of developing HCC: Child-Pugh A-B cirrhotic patients, all cirrhotic patients on the waiting list for liver transplantation, high-risk HBV chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and patients with chronic hepatitis C and bridging fibrosis. Accurate diagnosis, staging and functional hepatic reserve are crucial for the optimal therapeutic approach. Characteristic findings on dynamic CT/MR of arterial hyperenhancement with "washout" in the portal venous or delayed phase are highly specific and sensitive for a diagnosis of HCC in patients with previous cirrhosis, but a confirmed histopathologic diagnosis should be done in patients without previous evidence of chronic hepatic disease. BCLC classification is the most common staging system used in Western countries. Surgical procedures, local therapies and systemic treatments should be discussed and planned for each patient by a multidisciplinary team according to the stage, performance status, liver function and comorbidities. Surgical interventions remain as the only curative procedures but both local and systemic approaches may increase survival and should be offered to patients without contraindications.

Keywords: Ablative therapies; Guidelines; Hepatocellular carcinoma; Sorafenib.

Figures

Fig. 1
Fig. 1
HCC staging systems and parameters. Modificadd de benyamad et al. (Clin Liver Dis 19 (2015): 277–294). ECOG Eastern Cooperative Oncology Group, BCLC Barcelona Clinic Liver Cancer, CUPI SCORE Chinese University Prognostic Index, GRETCH Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire, MELD model for end-stage liver disease, ALBI albumin-bilirubin, OKUDA OKUDA staging system, CLIP Cancer of the Liver Italian Program, JIS Japanese integrated staging, bm-JIS biomarker-combined JIS, TNM tumor-node-metastasis staging
Fig. 2
Fig. 2
BCLC Barcelona Clinic Liver Cancer, PS performance status, N node classification, M metastasis classification, RFA radiofrequency ablation, TACE transcatheter arterial chemoembolization

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