Clinical practice guidelines and real-life practice on hepatocellular carcinoma: the Hong Kong perspective

Abstract

Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong.For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice.HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer (HKLC) Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer (BCLC) Staging and the Tumor-Node-Metastasis (TNM) Staging as well.Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy.Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers.Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.

The prime time for management of hepatocellular carcinoma in Hong Kong

“…Following diagnosis of HCC, treatment of curative intent could be achieved by liver resection, ablation, or transplantation for early-stage disease. 1 However, as noted by Hui et al 1 , recurrence rates occurred in over 70% for patients following hepatectomy. Conventionally, effective adjuvant treatment has been lacking for HCC.…”

“…In this issue of Clinical and Molecular Hepatology, the article 'the Hong Kong perspective of clinical management of HCC' written by Hui et al 1 represented a timely piece of summery on the real-life practice of management of hepatocellular carcinoma (HCC). In the past decade, we have witnessed remarkable advances on the surveillance, diagnosis, and treatment of HCC, which lead to changes in clinical practice and result in improved outcomes of patients.…”

“…As highlighted in the review paper, 1 the management of HCC has undergone a rapid development, and this is leading to another wave of practice-changing studies. For surveillance of HCC, the use of alpha-feroprotein (AFP) and abdominal ultrasound (US) is well-known to be associated with improved early detection, curative treatment receipt and survival in patients with cirrhosis.…”

“…It is anticipated that cell-free DNA will be an important tool for surveillance in the near future. 11 Hui et al 1 depicted the real-life practice in diagnosis of HCC in Hong Kong, which is mainly based on non-invasive tests http://www.e-cmh.org https://doi.org/10.3350/cmh.2023.0094 with contrast-enhanced imaging to identify the characteristic features of HCC. This is largely compatible with the recommendation of international guidelines.…”

“…For intermediate-stage disease, transarterial chemoembolization (TACE) remains a standard treatment. 1 However, TACE as the only recommended treatment in this heterogeneous group has recently been challenged. On one hand, systemic therapy is increasingly considered a better alternative for selected high-burden intermediate-stage HCC.…”