Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)

Jian Zhou¹, Huichuan Sun¹, Zheng Wang¹, Wenming Cong², Jianhua Wang³, Mengsu Zeng⁴, Weiping Zhou⁵, Ping Bie⁶, Lianxin Liu⁷, Tianfu Wen⁸, Guohong Han⁹, Maoqiang Wang¹⁰, Ruibao Liu¹¹, Ligong Lu¹², Zhengang Ren¹, Minshan Chen¹³, Zhaochong Zeng¹⁴, Ping Liang¹⁵, Changhong Liang¹⁶, Min Chen¹⁷, Fuhua Yan¹⁸, Wenping Wang¹⁹, Yuan Ji²⁰, Jingping Yun²¹, Dingfang Cai²², Yongjun Chen²³, Wenwu Cheng²⁴, Shuqun Cheng⁵, Chaoliu Dai²⁵, Wenzhi Guo²⁶, Baojin Hua²⁷, Xiaowu Huang¹, Weidong Jia²⁸, Yaming Li²⁹, Yexiong Li³⁰, Jun Liang³¹, Tianshu Liu³², Guoyue Lv³³, Yilei Mao³⁴, Tao Peng³⁵, Weixin Ren³⁶, Hongcheng Shi³⁷, Guoming Shi¹, Kaishan Tao³⁸, Wentao Wang⁸, Xiaoying Wang¹, Zhiming Wang³⁹, Bangde Xiang⁴⁰, Baocai Xing⁴¹, Jianming Xu⁴², Jiamei Yang⁵, Jianyong Yang⁴³, Yefa Yang⁴⁴, Yunke Yang²², Shenglong Ye¹, Zhengyu Yin⁴⁵, Bixiang Zhang⁴⁶, Boheng Zhang¹, Leida Zhang⁴⁷, Shuijun Zhang⁴⁸, Ti Zhang⁴⁹, Yongfu Zhao⁴⁸, Honggang Zheng⁵⁰, Jiye Zhu⁵¹, Kangshun Zhu⁵², Rong Liu³, Yinghong Shi¹, Yongsheng Xiao¹, Zhi Dai¹, Gaojun Teng⁵³, Jianqiang Cai⁵⁴, Weilin Wang⁵⁵, Xiujun Cai⁵⁶, Qiang Li⁴⁹, Feng Shen⁵, Shukui Qin⁵⁷, Jiahong Dong⁵⁸, Jia Fan¹

Affiliations

¹ Liver Cancer Institute, Zhongshan Hospital, 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 The Third Department of Hepatic Surgery, 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 Pathology, Tumor Prevention and Treatment Center, Sun Yat-sen University, Guangzhou, China.
²² Department of Integrative Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
²³ Department of Hematology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁴ Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.
²⁵ Department of Hepatobiliary and Spleenary Surgery, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China.
²⁶ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
²⁷ Graduate School, Beijing University of Chinese Medicine, Beijing, China.
²⁸ Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, China.
²⁹ Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China.
³⁰ Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³¹ Department of Oncology, Peking University International Hospital, Beijing, China.
³² Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
³³ Department of General Surgery, The First Hospital of Jilin University, Jilin, China.
³⁴ Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China.
³⁵ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁶ Department of Interventional Radiology The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
³⁷ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
³⁸ Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
³⁹ Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China.
⁴⁰ Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
⁴¹ Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
⁴² Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China.
⁴³ Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁴⁴ Department of Hepatic Surgery & Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
⁴⁵ Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, China.
⁴⁶ Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴⁷ Department of Hepatobiliary Surgery Institute, Southwest Hospital, Third Military Medical University, Chongqing, China.
⁴⁸ Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, ZhengZhou, China.
⁴⁹ Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
⁵⁰ Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
⁵¹ Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China.
⁵² Department of Minimally Invasive Interventional Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁵³ Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
⁵⁴ Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵⁵ Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵⁶ Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
⁵⁷ Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China.
⁵⁸ Department of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital (BTCH), School of Clinical Medicine, Tsinghua University, Beijing, China.

PMID: 33442540
PMCID: PMC7768108
DOI: 10.1159/000509424

Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)

Jian Zhou et al. Liver Cancer. 2020 Dec.

. 2020 Dec;9(6):682-720.

doi: 10.1159/000509424. Epub 2020 Nov 11.

Authors

Affiliations

¹ Liver Cancer Institute, Zhongshan Hospital, 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 The Third Department of Hepatic Surgery, 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 Pathology, Tumor Prevention and Treatment Center, Sun Yat-sen University, Guangzhou, China.
²² Department of Integrative Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
²³ Department of Hematology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁴ Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.
²⁵ Department of Hepatobiliary and Spleenary Surgery, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China.
²⁶ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
²⁷ Graduate School, Beijing University of Chinese Medicine, Beijing, China.
²⁸ Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, China.
²⁹ Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China.
³⁰ Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³¹ Department of Oncology, Peking University International Hospital, Beijing, China.
³² Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
³³ Department of General Surgery, The First Hospital of Jilin University, Jilin, China.
³⁴ Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China.
³⁵ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁶ Department of Interventional Radiology The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
³⁷ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
³⁸ Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
³⁹ Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China.
⁴⁰ Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
⁴¹ Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
⁴² Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China.
⁴³ Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁴⁴ Department of Hepatic Surgery & Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
⁴⁵ Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, China.
⁴⁶ Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴⁷ Department of Hepatobiliary Surgery Institute, Southwest Hospital, Third Military Medical University, Chongqing, China.
⁴⁸ Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, ZhengZhou, China.
⁴⁹ Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
⁵⁰ Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
⁵¹ Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China.
⁵² Department of Minimally Invasive Interventional Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁵³ Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
⁵⁴ Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵⁵ Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵⁶ Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
⁵⁷ Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China.
⁵⁸ Department of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital (BTCH), School of Clinical Medicine, Tsinghua University, Beijing, China.

PMID: 33442540
PMCID: PMC7768108
DOI: 10.1159/000509424

Abstract

Background: Primary liver cancer, around 90% are 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 (2017 Edition) in 2018, additional high-quality evidence has emerged with relevance to the diagnosis, staging, and treatment of liver cancer in and outside China that requires the guidelines to be updated. The new edition (2019 Edition) was written by more than 70 experts in the field of liver cancer in China. They reflect the real-world situation in China regarding diagnosing and treating liver cancer in recent years.

Key messages: Most importantly, the new guidelines were endorsed and promulgated by the Bureau of Medical Administration of the National Health Commission of the People's Republic of China in December 2019.

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

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

**Fig. 1**
Schematic diagram of the recommended baseline specimen sampling protocol for liver tumors. A, B, C, and D 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**
Pathway for the diagnosis of HCC. Typical characteristics: the “rapid in and rapid out” enhancement pattern that manifests as enhancement of lesions in the arterial phase and reduced enhancement in the portal venous or equilibrium phase of dynamic contrast-enhanced imaging. Atypical characteristics: absence of obvious enhancement of lesions in the arterial phase of dynamic contrast-enhanced imaging, or no reduction/no obvious reduction/mild increase in enhancement in the portal venous or equilibrium phase of dynamic contrast-enhanced imaging. MRI, dynamic contrast-enhanced MRI; CT, dynamic contrast-enhanced CT; CEUS, contrast-enhanced US. Ultrasound contrast agents are used for real-time observation of blood perfusion of normal and pathological tissues. EOB-MRI, contrast-enhanced MRI with the hepatocyte-specific contrast agent gadoxetic acid disodium (Gd-EOB-DTPA). AFP(+), serum AFP above the ULN; ULN, upper limit of normal; US, ultrasonography.

**Fig. 3**
China clinical staging and treatment pathway for HCC. Notes: FOLFOX4, 5-fluorouracil, leucovorin, and oxaliplatin; HCC, hepatocellular carcinoma; PS, performance status; TACE, transarterial chemoembolization; UCSF, University of California, San Francisco.

See this image and copyright information in PMC

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Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)

Affiliations

Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Medical