Comparison of the current international guidelines on the management of HCC

Abstract

The management of hepatocellular carcinoma (HCC) has become ever more demanding. To evaluate the available evidence and to give clinicians the best guidance, all major hepatology societies have developed guidelines for HCC. Recently, updated versions have been published by the American, the Asian Pacific, and the European societies. This article presents a comparison of these three guidelines summarising both common ground and differences. Moreover, it highlights areas of ongoing research which will make yet another round of updates of the guidelines necessary in the near future.

Treatment of Hepatocellular Carcinoma in the Precision Medicine Era: From Treatment Stage Migration to Therapeutic Hierarchy

“…The concept of "treatment stage alternative" introduces certain relevant differences between the AASLD and EASL guidelines, (2,3,13,40) which are as follows: the first-line therapy for BCLC 0 patients is LR in AASLD and ABL in EASL guidelines; radioembolization is considered a suitable option for BCLC A, B, and C stages only by the AASLD guidelines; and LT is included in the therapeutic armamentarium for BCLC B and D (after downstaging) patients in the AASLD guidelines, while this choice does not receive support by the European document.…”

“…A similar approach was followed in the latest AASLD guidelines, ( 2,40 ) which proposed different treatments for each BCLC stage, stratified according to the level of evidence (Fig. 3).…”

Editorial musings

“…3,4 The second HCC paper deals with a comparison between the guidelines presented by the 3 continental liver disease societies, EASL, APASL and AASLD. 5 What is obvious is that in broad strokes all 3 society guidelines are similar. All advocate for HCC surveillance in those at risk.…”

Fat, cancer, the gut-liver axis and rare liver diseases

“…The definitive treatment for HCC remains challenging, with 2 potentially curative options (hepatic resection and liver transplantation) for those in whom the cancer is detected at early stages. 9 In this issue, 4 different papers report on improvements in the management of HCC, with a focus on antiviral therapy against HBV, 10 predictive models of HCC risk, 11 the use of optimal imaging modalities 12 and optimised surgical approaches. 13 In a retrospective territory-wide cohort study, 10 the authors show that the secular trend of nucleoside analogue (NA) treatment uptake has increased over time among patients with HCC.…”