2018 Korean Liver Cancer Association and National Cancer Center for Clinical Practice Guidelines of Hepatocellular Carcinoma: What's Different from 2014?

Ji Hoon Kim

doi:10.4166/kjg.2019.74.2.101

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Kim: 2018 Korean Liver Cancer Association and National Cancer Center for Clinical Practice Guidelines of Hepatocellular Carcinoma: What's Different from 2014?

Brief Summary of Practice Guideline

The Korean Journal of Gastroenterology 2019; 74(2): 101-109.

Published online: 27 August 2019

DOI: https://doi.org/10.4166/kjg.2019.74.2.101

2018 Korean Liver Cancer Association and National Cancer Center for Clinical Practice Guidelines of Hepatocellular Carcinoma: What's Different from 2014?

Ji Hoon Kim

Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.

Correspondence to: Ji Hoon Kim, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea. Tel: +82-2-2626-3011, Fax: +82-2-2626-1038, kjhhepar@naver.com

Received 16 August 2019 Revised 18 August 2019 Accepted 18 August 2019

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The Korean clinical practice guidelines for the management of hepatocellular carcinoma (HCC) was originally enacted in 2004 by the Korean Liver Cancer Association (KLCA)-National Cancer Center (NCC) Korea in order to provide medical practitioners with specific medical information regarding HCC to help them facilitate their understanding of the disease and treatment of the patients. KLCA-NCC Korea practice guidelines for the management of HCC have been revised entirely two times in 2009, and 2014. Although several major international liver association have established and revised clinical practice guidelines, since the medical environment in each country is somewhat different depending on race, region, institution, and economic conditions, it is necessary to revise the Korean guidelines to that reflect our medical environments and own research results. In this review, major change and its background will be summarized about 2018 updated clinical practice guidelines for the management of HCC.

Keywords: Carcinoma, hepatocellular, Guideline, Therapeutics

Figures and Tables

Fig. 1

Diagnostic algorithm and recall policy in patients with a high risk of hepatocellular carcinoma.1 HCC, hepatocellular carcinoma. ^*Major imaging features for “definite” diagnosis of HCC are defined as arterial phase hyperenhancement with washout in portal venous, delayed or hepatobiliary phases. These criteria should be applied only to lesion which does not show either marked T2 hyperintensity or targetoid appearance on diffusion-weighted images or contrastenhanced sequence on contrast-enhanced US as second line exams, major imaging features include arterial hyperenhancement and mild washout with late onset (≥60 seconds); ^**In nodule(s) with some but not all of aforementioned major imaging features of HCC, category of “probable” HCC can be assigned only when lesion fulfills at least one item from each of following two categories of ancillary imaging features. Two categories which make up ancillary imaging features are findings favoring malignancy in general (mild-to-moderate T2 hyperintensity, restricted diffusion, hepatobiliary phase hypointensity, interval growth) and those favoring HCC in particular (non-enhancing capsule, mosaic architecture, nodule-innodule appearance, fat or blood products in mass). These criteria should be applied only to lesion which shows neither marked T2 hyperintensity nor targetoid appearance on diffusion-weighted images or contrast-enhanced sequences.

Fig. 2

Therapeutic strategy in advanced hepatocellular carcinoma based on present evidence. HCC, hepatocellular carcinoma; PD, progressed disease; PVT, portal vein thrombosis; AFP, alpha-fetoprotein. ^*In patients without main PVT and <50% tumor load; ^#In patients with AFP >400 ng/mL; ^?Cabozantinib trial included one patient of lenvatinib failure but the one had been assigned to placebo.

Table 1

Ancillary Imaging Features

Modified from The Korean Liver Cancer Association and National Cancer Center.1

HCC, hepatocellular carcinoma.

^*Threshold growth is now defined as increase in size of nodule by at least 5 mm and at sufficient rate: either ≥50% increase in size in ≤6 months or ≥100% increase in size in >6 months.

Table 2

First-line Treatment Recommendation According to mUICC Stage in Hepatocellular Carcinoma1

In HCC patients with Child-Pugh class A, no portal hypertension, and Eastern Cooperative Oncology Group 0–1. Other LRT means percutaneous ethanol injection, microwave ablation, and cryoablation.

mUICC, modified Union for International Cancer Control; VI, vascular or bile duct invasion; RFA, radiofrequency ablation; TACE, transarterial chemoembolization; LRT, locoregional therapy; EBRT, external beam radiation therapy; LT, liver transplantation; TARE, transarterial embolization; Vp, portal vein invasion.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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ORCID iDs: Ji Hoon Kim
https://orcid.org/0000-0003-3924-0434
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