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Review
. 2023 Apr 10;12(2):216-228.
doi: 10.21037/hbsn-22-469. Epub 2023 Mar 2.

A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights

Di-Yang Xie #  1 , Kai Zhu #  1 , Zheng-Gang Ren  1 , Jian Zhou  1   2 , Jia Fan  1   2 , Qiang Gao  1
Affiliations
Review

A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights

Di-Yang Xie et al. Hepatobiliary Surg Nutr. .

Abstract

Significant improvements in the management of hepatocellular carcinoma (HCC) during the past three years have urged the timely update of clinical guidelines in China. In brief, aMAP score is newly recommended as an effective risk stratification tool to predict HCC occurrence especially for non-cirrhotic patients. Biomarker-based surveillance including 7 micro-RNA panel and GALAD score are advocated to assist early diagnosis. China liver cancer (CNLC) staging system proposed in the 2017 guideline continues to be the standard model for staging with modifications in the treatment allocations. Conversion therapies using multi-modal, high intensity strategies are advocated to facilitate subsequent resection for patients with technically unresectable CNLC stage Ia, Ib, IIa HCC, or technically resectable IIb, IIIa HCC. Super-selective transcatheter arterial chemoembolization (TACE) with the assistance of Cone-Beam CT if necessary is recommended to guarantee the efficacy of TACE. Hepatic arterial infusion chemotherapy (HAIC) using oxaliplatin, fluorouracil, and leucovorin (FOLFOX) regimen alone or in combination with systemic therapy is recommended for TACE-refractory patients or for patients with locally advanced HCC. The systemic treatments for HCC have evolved considerably since atezolizumab plus bevacizumab, and suntilimab plus bevacizumab analogue showing superior survival benefit to sorafenib, and donafenib with comparable efficacy with sorafenib are added to the first-line treatments. In addition to regorafenib, apatinib, camrelizumab and tislelizumab are added as the second-line systemic therapies for patients who progressed on sorafenib. Updates in the 2022 Barcelona Clinic Liver Cancer (BCLC) guidelines and Japanese Society of Hepatology (JSH) consensus statement are also introduced and compared with the 2022 Chinese guidelines.

Keywords: Clinical practice guidelines; diagnosis; hepatocellular carcinoma; treatment algorithm.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-22-469/coif). All authors reports that this work was supported by National Natural Science Foundation of China (Nos. 82130077 and 81961128025), Basic Research Project from the Science and Technology Commission of Shanghai Municipality (Nos. 21JC1410100, 21JC1401200, 20JC1418900), and Natural Science Funds of Shanghai (No. 21ZR1413800). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparisons of staging and treatment algorithms of HCC between 2022 BCLC and 2022 Chinese guidelines. BCLC, Barcelona Clinic Liver Cancer; CNLC, China Liver Cancer Staging; LT, liver transplantation; TACE, transarterial chemoembolization; UCSF, University of California San Francisco; HC, hepatocellular carcinoma; PS, performance status.
See this image and copyright information in PMC

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