Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Jian Zhou¹, Hui-Chuan Sun¹, Zheng Wang¹, Wen-Ming Cong², Jian-Hua Wang³, Meng-Su Zeng⁴, Jia-Mei Yang⁵, Ping Bie⁶, Lian-Xin Liu⁷, Tian-Fu Wen⁸, Guo-Hong Han⁹, Mao-Qiang Wang¹⁰, Rui-Bao Liu¹¹, Li-Gong Lu¹², Zheng-Gang Ren¹, Min-Shan Chen¹³, Zhao-Chong Zeng¹⁴, Ping Liang¹⁵, Chang-Hong Liang¹⁶, Min Chen¹⁷, Fu-Hua Yan¹⁸, Wen-Ping Wang¹⁹, Yuan Ji²⁰, Wen-Wu Cheng²¹, Chao-Liu Dai²², Wei-Dong Jia²³, Ya-Ming Li²⁴, Ye-Xiong Li²⁵, Jun Liang²⁶, Tian-Shu Liu²⁷, Guo-Yue Lv²⁸, Yi-Lei Mao²⁹, Wei-Xin Ren³⁰, Hong-Cheng Shi³¹, Wen-Tao Wang⁸, Xiao-Ying Wang¹, Bao-Cai Xing³², Jian-Ming Xu³³, Jian-Yong Yang³⁴, Ye-Fa Yang³⁵, Sheng-Long Ye¹, Zheng-Yu Yin³⁶, Bo-Heng Zhang¹, Shui-Jun Zhang³⁷, Wei-Ping Zhou⁵, Ji-Ye Zhu³⁸, Rong Liu³, Ying-Hong Shi¹, Yong-Sheng Xiao¹, Zhi Dai¹, Gao-Jun Teng³⁹, Jian-Qiang Cai⁴⁰, Wei-Lin Wang⁴¹, Jia-Hong Dong⁴², Qiang Li⁴³, Feng Shen⁵, Shu-Kui Qin⁴⁴, Jia Fan¹

Affiliations

¹ Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, China.
² Department of Pathology, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
³ Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁵ Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
⁶ Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
⁷ Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
⁸ Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
⁹ Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
¹⁰ Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China.
¹¹ Department of Interventional Radiology, the Tumor Hospital of Harbin Medical University, Harbin, China.
¹² Department of Interventional Oncology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹³ Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁴ Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁵ Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
¹⁶ Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹⁷ Editorial Department of Chinese Journal of Digestive Surgery, Chongqing, China.
¹⁸ Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁹ Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
²¹ Department of integrated treatment, Tumor Hospital of Fudan University, Shanghai, China.
²² Department of Hepatobiliary and Spleenary Surgery, the Affiliated Shengjing Hospital, China Medical University, Shenyang, China.
²³ Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, China.
²⁴ Department of Nuclear Medicine, the First Hospital of China Medical University, Shenyang, China.
²⁵ Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁶ Department of Oncology, Peking University International Hospital, Beijing, China.
²⁷ Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁸ Department of General Surgery, the First Hospital of Jilin University, Jilin, China.
²⁹ Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China.
³⁰ Department of Interventional Radiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
³¹ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
³² Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
³³ Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China.
³⁴ Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³⁵ Department of Hepatic Surgery and Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
³⁶ Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China.
³⁷ Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³⁸ Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China.
³⁹ Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
⁴⁰ Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴¹ Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁴² Department of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital (BTCH), School of Clinical Medicine, Tsinghua University, Beijing, China.
⁴³ Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
⁴⁴ Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China.

PMID: 30319983
PMCID: PMC6167671
DOI: 10.1159/000488035

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Jian Zhou et al. Liver Cancer. 2018 Sep.

. 2018 Sep;7(3):235-260.

doi: 10.1159/000488035. Epub 2018 Jun 14.

Authors

Affiliations

¹ Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, China.
² Department of Pathology, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
³ Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁵ Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
⁶ Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
⁷ Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
⁸ Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
⁹ Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
¹⁰ Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China.
¹¹ Department of Interventional Radiology, the Tumor Hospital of Harbin Medical University, Harbin, China.
¹² Department of Interventional Oncology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹³ Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁴ Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁵ Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
¹⁶ Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹⁷ Editorial Department of Chinese Journal of Digestive Surgery, Chongqing, China.
¹⁸ Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁹ Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
²¹ Department of integrated treatment, Tumor Hospital of Fudan University, Shanghai, China.
²² Department of Hepatobiliary and Spleenary Surgery, the Affiliated Shengjing Hospital, China Medical University, Shenyang, China.
²³ Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, China.
²⁴ Department of Nuclear Medicine, the First Hospital of China Medical University, Shenyang, China.
²⁵ Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁶ Department of Oncology, Peking University International Hospital, Beijing, China.
²⁷ Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁸ Department of General Surgery, the First Hospital of Jilin University, Jilin, China.
²⁹ Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China.
³⁰ Department of Interventional Radiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
³¹ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
³² Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
³³ Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China.
³⁴ Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³⁵ Department of Hepatic Surgery and Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
³⁶ Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China.
³⁷ Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³⁸ Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China.
³⁹ Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
⁴⁰ Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴¹ Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁴² Department of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital (BTCH), School of Clinical Medicine, Tsinghua University, Beijing, China.
⁴³ Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
⁴⁴ Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China.

PMID: 30319983
PMCID: PMC6167671
DOI: 10.1159/000488035

Abstract

Background: Hepatocellular carcinoma (HCC) (about 85-90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people.

Summary: This guideline presents official recommendations of the National Health and Family Planning Commission of the People's Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations.

Key messages: The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

Keywords: Cancer; Carcinoma; China; Diagnosis; Liver; Treatment.

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Figures

**Fig. 1.**
Guidelines for diagnosis of liver cancer. *Typical manifestations*: defined as obvious enhancements of lesions during the enhanced arterial phase (mainly late arterial phase) and reductions in enhancements during the portal venous or delayed phase that exhibit an enhancement mode of “rapid wash in and out.” *Atypical manifestations*: in the absence of lesion enhancement in the arterial phase, or when there is no reduction or no obvious reduction or even a mild increase in enhancement noted in the portal venous and delayed phases. *Dynamic MRI*: defined as dynamic enhanced MRI scan. *Dynamic enhanced CT*: defined as dynamic enhanced triphasic scan. *CEUS*: defined as the real-time monitoring of blood flow perfusion of normal tissues and lesion tissues using ultrasonography contrast agents. *EOB-MRI*: defined as Gd-EOB-DTPA-enhanced MRI scan. *AFP+*: above the upper limits of normal of serum AFP.

**Fig. 2.**
Guidelines for treatment of liver cancer.

See this image and copyright information in PMC

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Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Affiliations

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

Full Text Sources

Medical