Abstract
In China, the majority of patients with hepatocellular carcinoma (HCC) result from long-term infection of hepatitis B. Pathologically, HCC is characterized by rich blood supply, multicentric origins, early vascular invasion and intrahepatic metastasis. Therefore, HCC is not a local disease but a systemic disease at the beginning of its occurrence. For this reason, a comprehensive treatment strategy should be adopted in the management of HCC, including local treatments (such as surgical resection, radiofrequency ablation, microwave ablation, chemical ablation and cryoablation, etc.), organ-level treatments [such as transcatheter arterial infusion of chemotherapy and transcatheter arterial chemoembolization (TACE)], and systemic treatments (such as immunotherapy, antiviral therapy and molecular targeted therapy, etc.). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive guideline of HCC, focusing on the following eight aspects (1) using hepaticarteriography, CT hepatic arteriography (CTHA), CT arterial portography (CTAP), lipiodol CT (Lp-CT), TACE-CT to find the intrahepatic lesion and make precise staging (2) TACE combined with ablation or ablation as the first choice of treatment for early stage or small HCC, while other therapies are considered only when ablation is not applicable (3) infiltrating HCC should be regarded as an independent subtype of HCC (4) minimally-invasive comprehensive treatment could be adopted in treating metastatic lymph nodes (5) multi-level subdivision of M-staging should be used for individualized treatment and predicting prognosis (6) HCC with severe hepatic decompensation is the only candidate criterion for liver transplantation (7) bio-immunotherapy, traditional Chinese medicine therapy, antiviral therapy, and psychosocial and psychopharmacological interventions should be advocated through the whole course of HCC treatment (8) implementation of multicenter randomized controlled trials of minimally-invasive therapy versus surgery for early and intermediate stage HCC is recommended.
Highlights
Primary liver cancer is the fourth most common malignant tumor and the third leading cause of cancer death in China, which seriously threatens the lives and health of Chinese people
85% of Hepatocellular carcinoma (HCC) cases are associated with hepatitis B virus (HBV) infection, and only approximately 10% are associated with hepatitis C virus (HCV) infection
The imaging examination methods used for HCC diagnosis primarily include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA), and positron emission tomography (PET)/CT
Summary
Primary liver cancer is the fourth most common malignant tumor and the third leading cause of cancer death in China, which seriously threatens the lives and health of Chinese people. The HCC guidelines developed by the Liver Disease Associations of the European countries, North America, and Japan are not fully applicable to HCC diagnosis and treatment in China. In 2015, Minimally Invasive Therapy in Oncology of Chinese Anti-Cancer association published an article in the “National Medical Journal of China” ( called “Zhonghua Yi Xue Za Zhi”) to preliminarily describe the strategy for minimally invasive, multidisciplinary and comprehensive diagnosis and treatment of HCC [5]. When choosing treatment strategies and methods, minimally invasive interventional therapy combined with multidisciplinary comprehensive treatment is preferred, and extensive wound damage should be avoided or reduced as much as possible This consensus integrates the clinical diagnosis and treatment strategies of HCC in China and aims to reflect the individualized, rational, and humanistic features of a constructive treatment regimen for HCC. Clinical diagnosis primarily depends on determination of cirrhosis history caused by chronic hepatitis (HBV and/or HCV) infection and/or other causes, serological diagnosis, and imaging diagnosis
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