Overview of Asian clinical practice guidelines for the management of hepatocellular carcinoma: An Asian perspective comparison

Abstract

Hepatocellular carcinoma (HCC) is highly prevalent and the third most common cause of cancer-related death in Asia. In contrast to the West, the main etiology of HCC in many Asian countries except Japan is chronic hepatitis B virus infection. Differences in the major causes of HCC lead to significant clinical and treatment differences. This review summarizes and compares guidelines on managing HCC from China, Hong Kong, Taiwan, Japan, and South Korea. From oncology and socio-economic perspectives, factors such as underlying diseases, staging methods, government policies, insurance coverage, and medical resources contribute to varying treatment strategies among countries. Furthermore, the differences in each guideline are fundamentally caused by the lack of incontrovertible medical evidence, and even existing results of clinical trials can be interpreted differently. This review will provide a complete overview of the current Asian guidelines for HCC in recommendations and in practice.

Keywords: Asia; Chronic hepatitis B; Hepatocellular carcinoma; Practice guideline.

Figure 1.

Modified Union for International Cancer Control (mUICC) stages.

Figure 2.

Staging and preferred treatment in the Hong Kong Liver Cancer Staging (HKLC) system. EVM, extravascular metastasis; ECOG, Eastern Cooperative Oncology Group; TACE, transarterial chemoembolization.

Figure 3.

China liver cancer staging (CNLC) system. HCC, hepatocellular carcinoma; PS, performance status.

Figure 4.

Asian Pacific Association for the Study of the Liver (APASL) guideline treatment algorithm. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; BSC, best supportive care.