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. 2024 Nov 1;110(11):7234-7244.
doi: 10.1097/JS9.0000000000001950.

Clinical guidelines for early hepatocellular carcinoma treatment options: a systematic review and bibliometric analysis

Chun-Ying Wu  1   2   3   4   5 , Lee-Yuan Lin  6   7 , Teng-Yu Lee  8   9 , Yao-Chun Hsu  10 , Chun-Chieh Yeh  11   12   13 , Chiehfeng Chen  14   15   16   17 , Yi-No Kang  16   17 , Tsai-Wei Huang  16   18   19   20
Affiliations

Clinical guidelines for early hepatocellular carcinoma treatment options: a systematic review and bibliometric analysis

Chun-Ying Wu et al. Int J Surg. .

Abstract

Background: Hepatocellular carcinoma remains a major cause of cancer-related mortality worldwide, with treatment options including radiofrequency ablation (RFA) and surgical resection. This study evaluates the evolving guidelines for these treatments to identify the current consensus and divergences.

Method: The authors conducted a systematic review following PRISMA 2020 guidelines of documents from 2017 to 2024 by major liver societies. The AGREE-II framework assessed guideline quality. This study is registered with PROSPERO (CRD42022342266).

Results: The authors analyzed 23 guidelines and noted significant shifts in treatment recommendations over recent updates. This analysis reveals an increasing endorsement of RFA for certain patient groups and sustained strong support for surgical resection based on robust evidence levels. All demonstrated high quality, with the 2023 Japan Guidelines receiving the highest AGREE-II score. A significant finding was the low level of stakeholder involvement in the development of guidelines.

Conclusion: The study highlights the dynamic nature of clinical guidelines for early-stage hepatocellular carcinoma, underscoring the need for ongoing updates and direct, high-quality comparative studies. The evolving recommendations for RFA, especially its role in managing small, localized tumors, reflect its emerging importance in the treatment paradigm.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

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Graphical abstract
Figure 1
Figure 1
Study selection process.
Figure 2
Figure 2
Clinical guideline recommendations in relation to evidence levels. (A) Relationship between references, guidelines, and recommendations; (B) levels of evidence between guidelines and recommendations; (C) research design between guidelines and recommendations.
See this image and copyright information in PMC

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