The Indian National Association for Study of the Liver (INASL) Consensus on Prevention, Diagnosis and Management of Hepatocellular Carcinoma in India: The Puri Recommendations

K. M. Mohandas ,Premashish Kar,Anil Arora,Shashi Paul ,Ajay Duseja,Ragesh B. Thandassery,Vinay Kumaran,Dipanjan Panda,H. Ramesh ,Subrat Kumar Acharya ,Mahesh Kumar Goenka ,Deepali Jain,Jeyamani Ramachandran,Hunny Sharma ,Vivek A. Saraswat,Manoj Kumar,Padaki Nagaraja Rao ,Ashish Kumar,Samir Shah ,Shivaram Prasad Singh

doi:10.1016/j.jceh.2014.04.003

Abstract

Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. There are no consensus guidelines on diagnosis and management of HCC in India. The Indian National Association for Study of the Liver (INASL) set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines for diagnosis and management of HCC, relevant to disease patterns and clinical practices in India. The Task-Force first identified various contentious issues on various aspects of HCC and these issues were allotted to individual members of the Task-Force who reviewed them in detail. The Task-Force used the Oxford Center for Evidence Based Medicine-Levels of Evidence of 2009 for developing an evidence-based approach. A 2-day round table discussion was held on 9th and 10th February, 2013 at Puri, Odisha, to discuss, debate, and finalize the consensus statements. The members of the Task-Force reviewed and discussed the existing literature at this meeting and formulated the INASL consensus statements for each of the issues. We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HCC in India.

Highlights

The Indian National Association for Study of the Liver (INASL) Consensus on Prevention, Diagnosis and Management of Hepatocellular Carcinoma in India: The Puri Recommendations
We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HEPATOCELLULAR CARCINOMA (HCC) in India. ( J CLIN EXP HEPATOL 2014;4:S3–S26)
INASL set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines on various clinical aspects of HCC, relevant to disease patterns and clinical practices in India

Summary

21. Following patients should be subjected to surveillance for HCC

Patients with cirrhosis Child's A and B cirrhotic patients of any etiology Child's C cirrhotic patients of any etiology who are listed for liver transplantation. The BCLC staging has been widely used as the standard means of assessing the prognosis for patients with HCC.[5] The BCLC classification, which was introduced in 1999102 and subsequently updated[53] is the only system that links the prognosis with treatment recommendations (Figure 2).[103] It is a useful assessment tool that incorporates data on the patient's performance status (constitutional symptoms due to cancer), number and size of nodules (the tumor burden), and liver function as determined by the Child–Pugh classification system. The Barcelona-Clinic Liver Cancer (BCLC) staging system is recommended for prognostic prediction and treatment allocation. (Evidence-1a, Grade-A)

34. Treatment stage migration

55. TACE is contra-indicated in patients with: Advanced liver disease

Findings

CONCLUSIONS