Asian Consensus Workshop Report: Expert Consensus Guideline for the Management of Intermediate and Advanced Hepatocellular Carcinoma in AsiaHan K.-H.a · Kudo M.f · Ye S.-L.h · Choi J.Y.c · Poon R.T.-P.i · Seong J.b · Park J.-W.e · Ichida T.g · Chung J.W.d · Chow P.j · Cheng A.-L.k
Departments of aInternal Medicine and bRadiation Oncology, Yonsei University College of Medicine, cDepartment of Internal Medicine, College of Medicine, Catholic University of Korea, and dDepartment of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, and eCenter for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, South Korea; fDepartment of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, and gJuntendo University Hospital of Shizuoka, Shizuoka, Japan; hZhongshan Hospital, Shanghai, and iDepartment of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China; jDepartment of General Surgery, Singapore General Hospital, Singapore; kDepartment of Oncology, National Taiwan University Hospital, Taipei, Taiwan, ROC
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Hepatocellular carcinoma (HCC) is a highly prevalent disease in many Asian countries, accounting for 80% of victims worldwide. Screening programs improve the detection of early HCC and have a positive impact on survival, but the majority of HCC patients in Asia still present with advanced stage disease. The treatment outcomes of HCC are affected by multiple variables, including liver function, performance status of the patient, and tumor stage. Therefore, it is not easy to apply a multidisciplinary therapeutic approach for optimal management. At present, limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia. Therefore, most patients are eligible for only palliative treatments. For optimal management, the treatment choice is guided by staging systems and treatment guidelines. Numerous staging systems have been proposed and treatment guidelines vary by region. According to the Barcelona Clinic Liver Cancer (BCLC) guideline based on evidence from randomized clinical trials, only transarterial chemoembolization (TACE) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC. However, treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach, hepatic arterial infusion chemotherapy, external radiation, and their combinations based on clinical experiences for intermediate and advanced stage HCC. Although TACE is the main therapeutic modality in the intermediate stage, overall therapeutic outcomes depend on the tumor size. In the advanced stage, the prognosis depends on the tumor status, e.g. major vessel invasion or extrahepatic spread. Thus, a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence-based data, which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC.
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