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Review
. 2023 Apr;29(2):206-216.
doi: 10.3350/cmh.2022.0402. Epub 2022 Dec 22.

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective

Diyang Xie  1 , Jieyi Shi  1 , Jian Zhou  1   2 , Jia Fan  1   2 , Qiang Gao  1
Affiliations
Review

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective

Diyang Xie et al. Clin Mol Hepatol. 2023 Apr.

Abstract

Liver cancer is the fourth most prevalent and the second most lethal cancer in China. Hepatitis B virus (HBV) infection represents a major risk factor for hepatocellular carcinoma (HCC). Liver ultrasonography plus alpha-fetoprotein every 6 months continues to be the predominant surveillance modality. The age-Male-ALBI-Platelets score was recommended in the recent 2022 Chinese guidelines to predict HCC occurrence. The Chinese liver cancer (CNLC) staging system proposed in the 2017 guidelines continues to be the standard model for staging with modifications in the treatment allocations. Considering the aggressive nature of HBV-associated HCC, multimodal and high-intensity strategies like the addition of immunotherapy-based systemic treatment to local therapies, including resection, ablation, and intra-arterial therapies, have been adopted in real-life practices in China. The latest Chinese guidelines recommend atezolizumab plus bevacizumab, suntilimab plus a bevacizumab analog, lenvatinib, sorafenib, donafenib, and FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy as first-line treatment without priority. Regorafenib, apatinib, camrelizumab, and tislelizumab have been added as second-line systemic therapies for patients who progressed on sorafenib. Systemic therapies adopted in real-life practice are sophisticated with various combination modalities and different sequences.

Keywords: Diagnosis; Guideline; Hepatocellular carcinoma; Treatment.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
The CNLC staging and treatment algorithms of HCC. CNLC, Chinese liver cancer; HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; PS, performance score; MDT, multi-disciplinary treatment; UCSF, university of California San Francisco.
See this image and copyright information in PMC

Comment in

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