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Review
. 2023 Apr;29(2):242-251.
doi: 10.3350/cmh.2023.0102. Epub 2023 Mar 20.

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

Hironori Koga  1   2 , Hideki Iwamoto  1   2 , Hiroyuki Suzuki  1   2 , Shigeo Shimose  1 , Masahito Nakano  1 , Takumi Kawaguchi  1
Affiliations
Review

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

Hironori Koga et al. Clin Mol Hepatol. 2023 Apr.

Abstract

Striking advances in systemic therapy for unresectable advanced hepatocellular carcinoma (HCC) have improved the average prognosis of patients with HCC. As a result, the guidelines for the treatment of HCC have changed significantly. However, various issues have emerged in clinical practice. First, there is no established biomarker that can predict response to systemic therapy. Second, there is no established treatment regimen after primary systemic therapy, including combined immunotherapy. Third, there is no established treatment regimen for intermediate-stage HCC. These points make the current guidelines ambiguous. In this review, we present the Japanese guidelines for the diagnosis and treatment of HCC based on the latest evidence; introduce various efforts mainly in Japanese real-life practice to update these guidelines; and present our perspectives on future guidelines.

Keywords: BCLC staging; Immune checkpoint inhibitors; Molecular-targeted agents; Radiofrequency ablation; Transcatheter arterial chemoembolization.

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Conflict of interest statement

Conflicts of Interest

H.K. received lecture fees from Chugai Pharmaceutical Co. Ltd. and Eisai Co. Ltd. T.K. received lecture fees from Janssen Pharmaceutical K.K., Taisho Pharmaceutical Co. Ltd., Kowa Company Ltd., Otsuka Pharmaceutical Co. Ltd., Eisai Co. Ltd., ASKA Pharmaceutical Co. Ltd., and AbbVie GK. T.K. received research funding from Eisai Co. Ltd. The other authors have no conflicts of interest pertaining to this study.

Figures

Figure 1.
Figure 1.
The staging system for HCC according to the General Rules for the Clinical and Pathological Study of Primary Liver Cancer (the Japan Liver Cancer Association). HCC, hepatocellular carcinoma; Meta, metastasis.
Figure 2.
Figure 2.
The treatment algorithm for HCC according to the Guidelines for Liver Cancer Treatment 2021 in Japan. The algorithm is based on five factors: hepatic functional reserve, extrahepatic metastasis, vascular invasion, tumor number, and tumor size. *1. Assessment based on liver damage is recommended in the case of hepatectomy; *2. Patients with Child–Pugh class A only; *3. Patients aged ≤65 years; and *4. No extrahepatic metastasis or vascular invasion. Five or fewer tumors, size ≤5 cm in diameter, and AFP ≤500 ng/mL. HCC, hepatocellular carcinoma; HAIC, hepatic arterial infusion chemotherapy; RFA, radiofrequency ablation; TACE, transcatheter arterial chemoembolization; AFP, alpha-fetoprotein.
See this image and copyright information in PMC

References

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