2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma

Abstract

The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.

Keywords: Carcinoma, hepatocellular; Guidelines; Management.

Fig. 1

Annual cases and incidence rate of hepatocellular carcinoma.

Fig. 2

Changes in the 5-year survival rates of overall cancers and hepatocellular carcinoma (HCC).

Fig. 3

Diagnostic algorithm. US, ultrasonography; HBV, hepatitis B virus; HCV, hepatitis C virus; AFP, α-fetoprotein; HCC, hepatocellular carcinoma; CT, computed tomography; MRI, magnetic resonance imaging; Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid. *HCC radiological hallmarks include arterial phase enhancement with washout in the portal or delayed phase; ^†For the diagnosis of nodules 1–2 cm in diameter, two or more imaging modalities are required if a suboptimal imaging technique is used.

Fig. 4

First-line treatment according to the 2014 KLCSG-NCC Korea Practice Guidelines for patients with HCC, Child-Pugh class A, no portal hypertension, and ECOG performance status 0–1. KLCSG, Korean Liver Cancer Study Group; NCC, National Cancer Center; HCC, hepatocellular carcinoma; ECOG, Eastern Cooperative Oncology Group; mUICC, modified Union for International Cancer Control; RFA, radiofrequency ablation; TACE, transarterial chemoembolization; PEIT, percutaneous ethanol injection therapy; EBRT, external-beam radiation therapy; LT, liver transplantation; DDLT, deceased donor LT; LDLT, living donor liver transplantation; VI, vascular or bile duct invasion.