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Vol. 29, No. 3, 2011
Issue release date: August 2011

Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Guidelines Proposed by the Japan Society of Hepatology (JSH) 2010 Updated Version

Kudo M. · Izumi N. · Kokudo N. · Matsui O. · Sakamoto M. · Nakashima O. · Kojiro M. · Makuuchi M. · for the HCC Expert Panel of Japan Society of Hepatology
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Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death not only in Japan but also worldwide. Clinical practice guidelines for HCC were first published in 2001 by the European Society of Study of the Liver (EASL) followed by the American Association for the Study of Liver Disease (AASLD) published in 2005 and updated in 2010. However, these guidelines have proven to be somewhat unsuitable for Japanese patients. In 2005, supported by the Japanese Ministry of Health, Labour and Welfare, evidence-based clinical practice guidelines for HCC were compiled in Japan. In 2009, a revised version of evidence-based guidelines was published. Based on both ‘evidence-based’ guidelines and the consensus of an expert panel on HCC, the Japan Society of Hepatology (JSH) published the Consensus-Based Clinical Practice Manual in 2007 and updated in 2010. In this article, the 2010 updated version of this manual, especially issues on prevention, surveillance, pathology, diagnosis, staging, and treatment algorithm are summarized.



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References

  1. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J: Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona 2000 EASL Conference. European Association for the Study of the Liver. J Hepatol 2001;35:421–430.
  2. Bruix J, Sherman M: Management of hepatocellular carcinoma. Hepatology 2005;42:1208–1236.
  3. Bruix J, Sherman M: Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020–1022.
  4. Group formed to establish ‘Guidelines for Evidence-Based Clinical Practice for the Treatment of Liver Cancer’: Clinical Practice Guidelines for Hepatocellular Carcinoma (in Japanese). Tokyo, Kanehara, 2005.
  5. Makuuchi M, Kokudo N, Arii S, Igaki H, Ikai I, Kaneko S, Kawasaki S, Kudo M, Matsuyama Y, Ohtomo K, et al: Surveillance algorithm and diagnostic algorithm for hepatocellular carcinoma. Hepatol Res 2010;40 (suppl 1):1–144.
  6. Makuuchi M, Kokudo N: Clinical practice guidelines for hepatocellular carcinoma: the first evidence-based guidelines from Japan. World J Gastroenterol 2006;12:828–829.
  7. Kokudo N, Sasaki Y, Nakayama T, Makuuchi M: Dissemination of evidence-based clinical practice guidelines for hepatocellular carcinoma among Japanese hepatologists, liver surgeons and primary care physicians. Gut 2007;56:1020–1021.
  8. Expert Panel of Japan Society of Hepatology: Clinical Practice Manual for Hepatocellular Carcinoma (in Japanese). Tokyo, Igaku-Shoin, 2007.
  9. Japan Society of Hepatology: Consensus-Based Clinical Practice Manual of Hepatocellular Carcinoma, ed 2 (in Japanese). Tokyo, Igaku-Shoin, 2010.
  10. Arii S, Sata M, Sakamoto M, Shimada M, Kumada T, Shiina S, Yamashita T, Kokudo N, Tanaka M, Takayama T, et al: Management of Hepatocellular Carcinoma: Report of Consensus Meeting in the 45th Annual Meeting of the Japan Society of Hepatology 2009. Hepatol Res 2010;40:667–685.
  11. Lin SM, Sheen IS, Chien RN, Chu CM, Liaw YF: Long-term beneficial effect of interferon therapy in patients with chronic hepatitis B virus infection. Hepatology 1999;29:971–975.
  12. Lin SM, Yu ML, Lee CM, Chien RN, Sheen IS, Chu CM, Liaw YF: Interferon therapy in HBeAg-positive chronic hepatitis reduces progression to cirrhosis and hepatocellular carcinoma. J Hepatol 2007;46:45–52.
  13. Camma C, Giunta M, Andreone P, Craxi A: Interferon and prevention of hepatocellular carcinoma in viral cirrhosis: an evidence-based approach. J Hepatol 2001;34:593–602.
  14. Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, Tao QM, Shue K, Keene ON, et al: Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531.
  15. Yuen MF, Seto WK, Chow DH, Tsui K, Wong DK, Ngai VW, Wong BC, Fung J, Yuen JC, Lai CL: Long-term lamivudine therapy reduces the risk of long-term complications of chronic hepatitis B infection even in patients without advanced disease. Antivir Ther 2007;12:1295–1303.
  16. Papatheodoridis GV, Dimou E, Dimakopoulos K, Manolakopoulos S, Rapti I, Kitis G, Tzourmakliotis D, Manesis E, Hadziyannis SJ: Outcome of hepatitis B e antigen-negative chronic hepatitis B on long-term nucleos(t)ide analog therapy starting with lamivudine. Hepatology 2005;42:121–129.
  17. Kasahara A, Hayashi N, Mochizuki K, Takayanagi M, Yoshioka K, Kakumu S, Iijima A, Urushihara A, Kiyosawa K, Okuda M, et al: Risk factors for hepatocellular carcinoma and its incidence after interferon treatment in patients with chronic hepatitis C. Osaka Liver Disease Study Group. Hepatology 1998;27:1394–1402.
  18. Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, Hsiao CK, Chen PJ, Chen DS, Chen CJ: Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Engl J Med 2002;347:168–174.
  19. Kurokawa M, Hiramatsu N, Oze T, Mochizuki K, Yakushijin T, Kurashige N, Inoue Y, Igura T, Imanaka K, Yamada A, et al: Effect of interferon-α2b plus ribavirin therapy on incidence of hepatocellular carcinoma in patients with chronic hepatitis. Hepatol Res 2009;39:432–438.
  20. Lok AS, Everhart JE, Wright EC, et al: Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C. Gastroenterology 2011;140:840–849.
  21. Arase Y, Ikeda K, Tsubota A, Suzuki F, Suzuki Y, Saitoh S, Kobayashi M, Akuta N, Someya T, Hosaka T, et al: Interferon therapy for two years or longer reduces the incidence of hepatocarcinogenesis in patients with chronic hepatitis C viral infection. Intervirology 2004;47:355–361.
  22. Omata M, Yoshida H, Toyota J, Tomita E, Nishiguchi S, et al: A large-scale, multicentre, double-blind trial of ursodeoxycholic acid in patients with chronic hepatitis C. Gut 2007;56:1747–1753.
  23. Kato J, Miyanishi K, Kobune M, Nakamura T, Takada K, Takimoto R, Kawano Y, Takahashi S, Takahashi M, Sato Y, et al: Long-term phlebotomy with low-iron diet therapy lowers risk of development of hepatocellular carcinoma from chronic hepatitis C. J Gastroenterol 2007;42:830–836.
  24. Sakamoto M, Hirohashi S, Shimosato Y: Early stages of multistep hepatocarcinogenesis: adenomatous hyperplasia and early hepatocellular carcinoma. Hum Pathol 1991;22:172–178.
  25. Nakashima O, Sugihara S, Kage M, Kojiro M: Pathomorphologic characteristics of small hepatocellular carcinoma: a special reference to small hepatocellular carcinoma with indistinct margins. Hepatology 1995;22:101–105.
  26. Liver Cancer Study Group of Japan: General Rules for the Clinical and Pathological Study of Primary Liver Cancer, Engl ed 3. Tokyo, Kanehara, 2010.
  27. Kondo F, Kondo Y, Nagato Y, Tomizawa M, Wada K: Interstitial tumour cell invasion in small hepatocellular carcinoma. Evaluation in microscopic and low magnification views. J Gastroenterol Hepatol 1994;9:604–612.
  28. International Consensus Group for Hepatocellular Neoplasia: Pathologic diagnosis of early hepatocellular carcinoma: a report of the International Consensus Group for Hepatocellular Neoplasia. Hepatology 2009;49:658–664.
  29. Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M: Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol 2000;33:282–289.
  30. Kudo M: Will Gd-EOB-MRI change the diagnostic algorithm in hepatocellular carcinoma? Oncology 2010;78:S87–S93.
  31. Nakashima Y, Nakashima O, Tanaka M, Okuda K, Nakashima M, Kojiro M: Portal vein invasion and intrahepatic micrometastasis in small hepatocellular carcinoma by gross type. Hepatol Res 2003;26:142–147.
  32. Kudo M: Atypical large well-differentiated hepatocellular carcinoma with benign nature: a new clinical entity. Intervirology 2004;47:227–237.
  33. Kumano S, Uemura M, Haraikawa T, Hirata M, Kikuchi K, Kim T, Okada M, Mochizuki T, Murakami T: Efficacy of double arterial phase dynamic magnetic resonance imaging with the sensitivity encoding technique versus dynamic multidetector-row helical computed tomography for detecting hypervascular hepatocellular carcinoma. Jpn J Radiol 2009;27:229–236.

    External Resources

  34. Ueda K, Matsui O, Kawamori Y, Nakanuma Y, Kadoya M, Yoshikawa J, Gabata T, Nonomura A, Takashima T: Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology 1998;206:161–166.
  35. Shapiro RS, Katz R, Mendelson DS, Halton KP, Schwartz ME, Miller CM: Detection of hepatocellular carcinoma in cirrhotic patients: sensitivity of CT and ultrasonography. J Ultrasound Med 1996;15:497–502.
  36. Lim JH, Kim CK, Lee WJ, Park CK, Koh KC, Paik SW, Joh JW: Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol 2000;175:693–698.
  37. Peterson MS, Baron RL, Marsh JW Jr, Oliver JH 3rd, Confer SR, Hunt LE: Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology 2000;217:743–749.
  38. Hatanaka K, Kudo M, Minami Y, Ueda T, Tatsumi C, Kitai S, Takahashi S, Inoue T, Hagiwara S, Chung H, et al: Differential diagnosis of hepatic tumors: value of contrast-enhanced harmonic sonography using the newly developed contrast agent, Sonazoid. Intervirology 2008;51:S61–S69.
  39. Kudo M, Hatanaka K, Maekawa K: Newly developed novel ultrasound technique, defect reperfusion ultrasound imaging, using Sonazoid in the management of hepatocellular carcinoma. Oncology 2010;78(suppl 1):40–45.
  40. Kudo M, Hatanaka K, Kumada T, Toyoda H, Tada T: Double contrast ultrasound: a novel surveillance tool for hepatocellular carcinoma. Am J Gastroenterol 2011;106:368–370.

    External Resources

  41. Kudo M, Hatanaka.K., Maekawa K: Defect reperfusion imaging, a newly developed novel technology using Sonazoid in the treatment of hepatocellular carcinoma. J Med Ultrasound 2008;16:169–175.

    External Resources

  42. Minami Y, Kudo M, Hatanaka K, Kitai S, Inoue T, Hagiwara S, Chung H, Ueshima K: Radiofrequency ablation guided by contrast harmonic sonography using perfluorocarbon microbubbles (Sonazoid) for hepatic malignancies: an initial experience. Liver Int 2010;30:759–764.
  43. Rode A, Bancel B, Douek P, Chevallier M, Vilgrain V, Picaud G, Henry L, Berger F, Bizollon T, Gaudin JL, et al: Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 2001;25:327–336.
  44. Kubota K, Hisa N, Nishikawa T, Fujiwara Y, Murata Y, Itoh S, Yoshida D, Yoshida S: Evaluation of hepatocellular carcinoma after treatment with transcatheter arterial chemoembolization: comparison of lipiodol-CT, power Doppler sonography, and dynamic MRI. Abdom Imaging 2001;26:184–190.
  45. Van Montfoort JE, Stieger B, Meijer DK, Weinmann HJ, Meier PJ, Fattinger KE: Hepatic uptake of the magnetic resonance imaging contrast agent gadoxetate by the organic anion transporting polypeptide OATP1. J Pharmacol Exp Ther 1999;290:153–157.
  46. Pascolo L, Petrovic S, Cupelli F, Bruschi CV, Anelli PL, Lorusso V, Visigalli M, Uggeri F, Tiribelli C: Abc protein transport of MRI contrast agents in canalicular rat liver plasma vesicles and yeast vacuoles. Biochem Biophys Res Commun 2001;282:60–66.
  47. Narita M, Hatano E, Arizono S, Miyagawa-Hayashino A, Isoda H, Kitamura K, Taura K, Yasuchika K, Nitta T, Ikai I, et al: Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol 2009;44:793–798.
  48. Kitao A, Zen Y, Matsui O, Gabata T, Kobayashi S, Koda W, Kozaka K, Yoneda N, Yamashita T, Kaneko S, et al: Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR imaging – correlation with molecular transporters and histopathologic features. Radiology 2010;256:817–826.

    External Resources

  49. Kudo M: The 2008 Okuda Lecture. Management of hepatocellular carcinoma: from surveillance to molecular targeted therapy. J Gastroenterol Hepatol 2010:439–452.

    External Resources

  50. Nakayama A, Imamura H, Matsuyama Y, Kitamura H, Miwa S, Kobayashi A, Miyagawa S, Kawasaki S: Value of lipiodol computed tomography and digital subtraction angiography in the era of helical biphasic computed tomography as preoperative assessment of hepatocellular carcinoma. Ann Surg 2001;234:56–62.
  51. Kojiro M: Pathology of hepatocellular carcinoma; in Okuda K, Tabor E (eds): Liver Cancer. New York, Churchill Livingstone, 1997.
  52. Sakamoto M, Hirohashi S: Natural history and prognosis of adenomatous hyperplasia and early hepatocellular carcinoma: multi-institutional analysis of 53 nodules followed up for more than 6 months and 141 patients with single early hepatocellular carcinoma treated by surgical resection or percutaneous ethanol injection. Jpn J Clin Oncol 1998;28:604–608.
  53. Hayashi M, Matsui O, Ueda K, Kawamori Y, Gabata T, Kadoya M: Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intra-arterial injection of contrast material. Radiology 2002;225:143–149.
  54. Tajima T, Honda H, Taguchi K, Asayama Y, Kuroiwa T, Yoshimitsu K, Irie H, Aibe H, Shimada M, Masuda K: Sequential hemodynamic change in hepatocellular carcinoma and dysplastic nodules: CT angiography and pathologic correlation. AJR Am J Roentgenol 2002;178:885–897.
  55. Kudo M, Hatanaka K, Maekawa K: Sonazoid-enhanced ultrasound in the diagnosis and treatment of hepatic tumors. J Med Ultrasound 2008;16:130–139.

    External Resources

  56. Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K: Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985;56:918–928.
  57. Llovet JM, Bru C, Bruix J: Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999;19:329–338.
  58. Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. The Cancer of the Liver Italian Program (CLIP) Investigators. Hepatology 2000;31:840–845.
  59. Kudo M, Chung H, Osaki Y: Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003;38:207–215.
  60. Kudo M, Chung H, Haji S, Osaki Y, Oka H, Seki T, Kasugai H, Sasaki Y, Matsunaga T: Validation of a new prognostic staging system for hepatocellular carcinoma: the JIS score compared with the CLIP score. Hepatology 2004;40:1396–1405.
  61. Tateishi R, Yoshida H, Shiina S, Imamura H, Hasegawa K, Teratani T, Obi S, Sato S, Koike Y, Fujishima T, et al: Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients. Gut 2005;54:419–425.
  62. Ikai I, Takayasu K, Omata M, Okita K, Nakanuma Y, Matsuyama Y, Makuuchi M, Kojiro M, Ichida T, Arii S, et al: Liver Cancer Study Group of Japan: A modified Japan integrated stage score for prognostic assessment in patients with hepatocellular carcinoma. J Gastroenterol 2006;41:884–892.
  63. Kitai S, Kudo M, Minami Y, Haji S, Osaki Y, Oka H, Seki T, Kasugai H, Sasaki Y, Matsunaga T: Validation of a new prognostic staging system for hepatocellular carcinoma: a comparison of the biomarker-combined Japan integrated staging score, the conventional Japan integrated staging score and the BALAD score. Oncology 2008;75(suppl 1): 83–90.
  64. The Japan Society of Hepatology: Evidence-Based Clinical Practice Guidelines for Hepatocellular Carcinoma, revised version (in Japanese). Tokyo, Kanehara, 2009.
  65. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, et al: Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378–390.
  66. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, et al: Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009;10:25–34.
  67. Kudo M, Okanoue T: Management of hepatocellular carcinoma in Japan: consensus-based clinical practice manual proposed by the Japan Society of Hepatology. Oncology 2007;72:S2–S15.


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