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Review
. 2023 Apr;29(2):217-229.
doi: 10.3350/cmh.2022.0399. Epub 2022 Dec 28.

Clinical practice guidelines and real-life practice on hepatocellular carcinoma: the Hong Kong perspective

Rex Wan-Hin Hui  1 , Lung-Yi Mak  1   2 , Tan-To Cheung  2   3 , Victor Ho-Fun Lee  4 , Wai-Kay Seto  1   2 , Man-Fung Yuen  1   2
Affiliations
Review

Clinical practice guidelines and real-life practice on hepatocellular carcinoma: the Hong Kong perspective

Rex Wan-Hin Hui et al. Clin Mol Hepatol. 2023 Apr.

Abstract

Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.

Keywords: Hepatectomy; Hepatitis B; Hepatocellular carcinoma; Immunotherapy; Liver transplantation.

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Conflict of interest statement

Conflicts of Interest

MF Yuen is an advisory board member and/or received research funding from AbbVie, Arbutus Biopharma, Assembly Biosciences, Bristol Myer Squibb, Dicerna Pharmaceuticals, MF Yuen is an advisory board member and/or received reBiosciences, Bristol Myer Squibb, Dicerna Pharmaceuticals, GlaxoSmithKline, Gilead Sciences, Janssen, Merck Sharp and Dohme, Clear B Therapeutics, Springbank Pharmaceuticals; and received research funding from Arrowhead Pharmaceuticals, Fujirebio Incorporation and Sysmex Corporation. WK Seto received speaker’s fees from AstraZeneca and Mylan, is an advisory board member of CSL Behring, is an advisory board member and received speaker’s fees from AbbVie, and is an advisory board member, received speaker’s fees and researching funding from Gilead Sciences. The remaining authors have no conflict of interests.

Figures

Figure 1.
Figure 1.
Management framework for hepatocellular carcinoma in Hong Kong. AFP, alpha-fetoprotein; CT, computed tomography; MR, magnetic resonance; PET-CT, positron emission tomography-computed tomography; USG, ultrasound.
Figure 2.
Figure 2.
Staging and preferred treatment in the Hong Kong Liver Cancer Staging System. ECOG, Eastern Cooperative Oncology Group; EVM, extrahepatic vascular invasion or metastasis; TACE, transarterial chemoembolization; HKLC, Hong Kong Liver Cancer. *Early tumor: ≤5 cm+≤3 tumor nodules+No intrahepatic venous invasion; Intermediate tumor: ≤5 cm+>3 tumor nodules/Intrahepatic venous invasion OR >5 cm+≤3 tumor nodules+No intrahepatic venous invasion; Locally-advanced tumor: ≤5 cm+>3 tumor nodules+intrahepatic venous invasion OR >5 cm+>3 tumor nodules+intrahepatic venous invasion OR diffuse tumor.
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Comment in

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