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

doi:10.1007/s12072-017-9799-9

Review

. 2017 Jul;11(4):317-370.

doi: 10.1007/s12072-017-9799-9. Epub 2017 Jun 15.

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

Masao Omata^{1

2}, Ann-Lii Cheng³, Norihiro Kokudo⁴, Masatoshi Kudo⁵, Jeong Min Lee⁶, Jidong Jia⁷, Ryosuke Tateishi⁸, Kwang-Hyub Han⁹, Yoghesh K Chawla¹⁰, Shuichiro Shiina¹¹, Wasim Jafri¹², Diana Alcantara Payawal¹³, Takamasa Ohki¹⁴, Sadahisa Ogasawara¹⁵, Pei-Jer Chen¹⁶, Cosmas Rinaldi A Lesmana^{17

18}, Laurentius A Lesmana¹⁷, Rino A Gani¹⁸, Shuntaro Obi¹⁹, A Kadir Dokmeci²⁰, Shiv Kumar Sarin²¹

Affiliations

¹ Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu-city, Yamanashi, Japan. aug8808@yahoo.co.jp.
² The University of Tokyo, Tokyo, Japan. aug8808@yahoo.co.jp.
³ Department of Oncology and Internal Medicine, National Taiwan University Hospital, National Taiwan University Cancer Center and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan.
⁴ Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan.
⁶ Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁷ Beijing Key Laboratory of Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
⁸ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁹ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
¹⁰ Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹¹ Department of Gastroenterology, Juntendo University, Tokyo, Japan.
¹² Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan.
¹³ Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines.
¹⁴ Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
¹⁵ Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹⁶ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹⁷ Digestive Disease and GI Oncology Center, Medistra Hospital, University of Indonesia, Jakarta, Indonesia.
¹⁸ Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
¹⁹ Third Department of Internal Medicine, Teikyo University School of Medicine, Chiba, Japan.
²⁰ Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
²¹ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

PMID: 28620797
PMCID: PMC5491694
DOI: 10.1007/s12072-017-9799-9

Review

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

Masao Omata et al. Hepatol Int. 2017 Jul.

. 2017 Jul;11(4):317-370.

doi: 10.1007/s12072-017-9799-9. Epub 2017 Jun 15.

Authors

Affiliations

¹ Department of Gastroenterology, Yamanashi Prefectural Central Hospital, Kofu-city, Yamanashi, Japan. aug8808@yahoo.co.jp.
² The University of Tokyo, Tokyo, Japan. aug8808@yahoo.co.jp.
³ Department of Oncology and Internal Medicine, National Taiwan University Hospital, National Taiwan University Cancer Center and Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan.
⁴ Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan.
⁶ Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁷ Beijing Key Laboratory of Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
⁸ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁹ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
¹⁰ Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹¹ Department of Gastroenterology, Juntendo University, Tokyo, Japan.
¹² Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan.
¹³ Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines.
¹⁴ Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
¹⁵ Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹⁶ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹⁷ Digestive Disease and GI Oncology Center, Medistra Hospital, University of Indonesia, Jakarta, Indonesia.
¹⁸ Department of Internal Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.
¹⁹ Third Department of Internal Medicine, Teikyo University School of Medicine, Chiba, Japan.
²⁰ Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
²¹ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

PMID: 28620797
PMCID: PMC5491694
DOI: 10.1007/s12072-017-9799-9

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.

PubMed Disclaimer

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**
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**
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

See this image and copyright information in PMC

Cited by

Gadoxetate-enhanced Abbreviated MRI for Hepatocellular Carcinoma Surveillance: Preliminary Experience.
Brunsing RL, Chen DH, Schlein A, Wolfson T, Gamst A, Mamidipalli A, Vietti Violi N, Marks RM, Taouli B, Loomba R, Kono Y, Sirlin CB. Brunsing RL, et al. Radiol Imaging Cancer. 2019 Nov 29;1(2):e190010. doi: 10.1148/rycan.2019190010. eCollection 2019 Nov. Radiol Imaging Cancer. 2019. PMID: 33778680 Free PMC article.
Development of a preoperative prognostic scoring system to predict benefits of hepatic resection in advanced hepatocellular carcinoma patients.
Chen CZ, Zhong JH, Qi YP, Zhang J, Huang T, Ma L, Li LQ, Peng T, Xiang BD. Chen CZ, et al. Biosci Rep. 2021 Apr 30;41(4):BSR20201928. doi: 10.1042/BSR20201928. Biosci Rep. 2021. PMID: 33835138 Free PMC article.
The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study.
Mähringer-Kunz A, Steinle V, Kloeckner R, Schotten S, Hahn F, Schmidtmann I, Hinrichs JB, Düber C, Galle PR, Lang H, Weinmann A. Mähringer-Kunz A, et al. PLoS One. 2021 May 7;16(5):e0249426. doi: 10.1371/journal.pone.0249426. eCollection 2021. PLoS One. 2021. PMID: 33961627 Free PMC article.
Endotrophin, a pro-peptide of Type VI collagen, is a biomarker of survival in cirrhotic patients with hepatocellular carcinoma.
Leeming DJ, Nielsen SH, Vongsuvanh R, Uchila P, Nielsen MJ, Reese-Petersen AL, van der Poorten D, Eslam M, Schuppan D, Karsdal MA, George J. Leeming DJ, et al. Hepat Oncol. 2020 Dec 18;8(2):HEP32. doi: 10.2217/hep-2020-0030. Hepat Oncol. 2020. PMID: 34084451 Free PMC article.
Current status of image-based surveillance in hepatocellular carcinoma.
Kim DH, Choi JI. Kim DH, et al. Ultrasonography. 2021 Jan;40(1):45-56. doi: 10.14366/usg.20067. Epub 2020 Jul 25. Ultrasonography. 2021. PMID: 33045812 Free PMC article.

See all "Cited by" articles

References

1. World Health Organaization. Cancer. http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed 16 April 2017
1. European Association For The Study of the Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56:908–943 - PubMed
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. doi: 10.1016/S0140-6736(12)61728-0. - DOI - PMC - PubMed
1. Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 2010;4:439–474. doi: 10.1007/s12072-010-9165-7. - DOI - PMC - PubMed
1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. doi: 10.1136/bmj.39489.470347.AD. - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- The Lens - Patent Citations Database
- scite Smart Citations
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information

[1] World Health Organaization. Cancer. http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed 16 April 2017

[2] World Health Organaization. Cancer. http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed 16 April 2017

[3] European Association For The Study of the Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56:908–943 - PubMed

[4] European Association For The Study of the Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56:908–943 - PubMed

[5] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. doi: 10.1016/S0140-6736(12)61728-0. - DOI - PMC - PubMed

[6] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. doi: 10.1016/S0140-6736(12)61728-0. - DOI - PMC - PubMed

[7] Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 2010;4:439–474. doi: 10.1007/s12072-010-9165-7. - DOI - PMC - PubMed

[8] Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 2010;4:439–474. doi: 10.1007/s12072-010-9165-7. - DOI - PMC - PubMed

[9] Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. doi: 10.1136/bmj.39489.470347.AD. - DOI - PMC - PubMed

[10] Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. doi: 10.1136/bmj.39489.470347.AD. - DOI - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical