Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective

• Published in: Clinical and molecular hepatology Vol. 29; no. 2; pp. 206 - 216
• Main Authors: Xie, Diyang, Shi, Jieyi, Zhou, Jian, Fan, Jia, Gao, Qiang
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of the Liver 01.04.2023; The Korean Association for the Study of the Liver
• Subjects: Alcohol abuse; Bevacizumab; Cancer therapies; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - therapy; Chemoembolization; Chemotherapy; diagnosis; Embolization; guideline; Hepatectomy; Hepatitis B; Hepatitis C; hepatocellular carcinoma; Humans; Immunotherapy; Infections; Inhibitor drugs; Laparoscopy; Liver cancer; Liver cirrhosis; Liver Neoplasms - diagnosis; Liver Neoplasms - therapy; Magnetic resonance imaging; Male; Monoclonal antibodies; Review; Sorafenib; Surveillance; treatment; San Francisco California; California; United States > US; China; Japan; Guideline; Hepatocellular carcinoma; Treatment; Diagnosis
• ISSN: 2287-2728; 2287-285X; 2287-285X
• DOI: 10.3350/cmh.2022.0402

Liver cancer is the fourth most prevalent and the second most lethal cancer in China. Hepatitis B virus (HBV) infection represents a major risk factor for hepatocellular carcinoma (HCC). Liver ultrasonography plus alpha-fetoprotein every 6 months continues to be the predominant surveillance modality. The age-Male-ALBI-Platelets score was recommended in the recent 2022 Chinese guidelines to predict HCC occurrence. The Chinese liver cancer (CNLC) staging system proposed in the 2017 guidelines continues to be the standard model for staging with modifications in the treatment allocations. Considering the aggressive nature of HBV-associated HCC, multimodal and high-intensity strategies like the addition of immunotherapy-based systemic treatment to local therapies, including resection, ablation, and intra-arterial therapies, have been adopted in real-life practices in China. The latest Chinese guidelines recommend atezolizumab plus bevacizumab, suntilimab plus a bevacizumab analog, lenvatinib, sorafenib, donafenib, and FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy as first-line treatment without priority. Regorafenib, apatinib, camrelizumab, and tislelizumab have been added as second-line systemic therapies for patients who progressed on sorafenib. Systemic therapies adopted in real-life practice are sophisticated with various combination modalities and different sequences.