Clinical guideline SEOM: hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) represents the second leading cause of cancer-related death worldwide. Surveillance with abdominal ultrasound every 6 months should be offered to patients with a high risk of developing HCC: Child-Pugh A–B cirrhotic patients, all cirrhotic patients on the waiting list for liver transplantation, high-risk HBV chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and patients with chronic hepatitis C and bridging fibrosis. Accurate diagnosis, staging and functional hepatic reserve are crucial for the optimal therapeutic approach. Characteristic findings on dynamic CT/MR of arterial hyperenhancement with “washout” in the portal venous or delayed phase are highly specific and sensitive for a diagnosis of HCC in patients with previous cirrhosis, but a confirmed histopathologic diagnosis should be done in patients without previous evidence of chronic hepatic disease. BCLC classification is the most common staging system used in Western countries. Surgical procedures, local therapies and systemic treatments should be discussed and planned for each patient by a multidisciplinary team according to the stage, performance status, liver function and comorbidities. Surgical interventions remain as the only curative procedures but both local and systemic approaches may increase survival and should be offered to patients without contraindications.

Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines

“…In several guidelines, a more precise indication is given. According to the Spanish guidelines,17 LR is preferred in patients with early stage HCC who have no cirrhosis and an anticipated liver remnant of at least 20% 4. According to the ESMO-ESDO guidelines,16 resection is the recommended treatment in patients without advanced fibrosis, as long as an R0 resection can be carried out without causing postoperative liver failure due to a too small liver remnant 20.…”

“…The SEOM guidelines17 recommend LR for patients with solitary or limited multifocal HCC (stage BCLC-0 and BCLC-A), with no major vascular invasion or extrahepatic spread, no portal hypertension (defined as hepatic venous pressure gradient <11 mm Hg or platelet count >100 000), adequate liver reserve and an anticipated liver remnant of at least 30–40% 4. Patients within Milan criteria could be considered for LT from either a dead or living donor 17…”

“…If the inclusion criteria were met, the manuscript was analysed. The search on the database in English language retrieved following guidelines: American (American Association for the Study of Liver Diseases (AASLD)),3 Asian (Asian Pacific Association for the Study of Liver (APASL)),11 Hong Kong,12 Japanese (Japan Society of Hepatology (JSH)),13 14 European Association for the study of liver-European Organization for Research and Treatment of Cancer (EASL-EORTC)15 and ESMO-ESDO16 and Spanish (Sociedad Espanola de Oncologia Medica (SEOM)) 17. The Spanish guidelines and the evidence-based Japanese guidelines are a synopsis.…”

Screening for hepatocellular carcinoma: summary of current guidelines up to 2018

“…Stage C cirrhosis is excluded from screening except for transplant candidates . However; SEOM-2015 guideline excluded Child C patients from screening (unless awaiting for liver transplantation) like EASL [37] . This section was summarized in Table 1.…”

“…However, SEOM-2015 recommended screening for high-risk HBV chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and non-cirrhotic patients with chronic hepatitis C and advanced fibrosis (F3) [37] . ESMO-ESDO-2012 recommendations are similar to SEOM-2015, which suggests to non-cirrhotic HBV carriers with high viral load (> 10.000 copy/mL) and non-cirrhotic patients with chronic hepatitis C and advanced cirrhosis [36] .…”