NCCN Guidelines Insights: Hepatobiliary Cancers, Version 1.2017

Abstract

The NCCN Guidelines for Hepatobiliary Cancers provide treatment recommendations for cancers of the liver, gallbladder, and bile ducts. The NCCN Hepatobiliary Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel’s discussion and most recent recommendations regarding locoregional therapy for treatment of patients with hepatocellular carcinoma.

Systematic review of guidelines for management of intermediate hepatocellular carcinoma using the Appraisal of Guidelines Research and Evaluation II instrument

“…The full text of the remaining 43 citations was assessed and 22 citations were excluded because they were not related to the management of HCC, were not clinical practice guidelines or consensus statements or were guidelines replaced by an updated version. Ultimately, 14 clinical practice guidelines [3,[16][17][18][19][20][21][22][23][24][25][26][27][28] and 7 consensus statements [29][30][31][32][33][34][35] were included. Sixteen of these documents were retrieved through searching medical databases [3,[16][17][18][19][21][22][23][24][25][26][27][28][29][30][31], the others through the search of guideline databases and professional society websites [20,[32][33][34][35].…”

The clinical management of hepatocellular carcinoma worldwide: A concise review and comparison of current guidelines from 2001 to 2017

“…In line with the criteria above, 18 guidelines that were published between 2001 and 2017 were identified for analysis, including 8 guidelines from Asia, 5 from Europe, and 5 from the United States of America (USA) ( Table 1) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). These 18 characteristic guidelines were examined with a focus on the clinical management of HCC, and surveillance, diagnosis, and treatment in those guidelines were compared.…”

“…HCC has been proven to be linked to liver disease independently and its major risk factors can be divided into those that are cirrhosis-related and those that are non-cirrhosis-related. The former includes hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, alcoholic cirrhosis, genetic causes (hemochromatosis and tyrosinosis), nonalcoholic steatohepatitis, stage IV primary biliary cirrhosis, alpha one antitrypsin deficiency, and other causes of cirrhosis; the latter includes being an HBV carrier with a family history of HCC, being Asian and elderly (males ≥ 40 years and females ≥ 40 years), and being an African/North American black infected with hepatitis B (28,29). Among these risk factors, hepatitis B is the leading cause of HCC in Africa and East Asia while hepatitis C is the leading cause in Europe, Japan, and North America (30,31).…”

“…However, several studies indicated that AFP alone are has limited and inconsistent sensitivity and specificity as a screening biomarker, and elevated levels of AFP may be found in < 20% of patients with early-stage HCC (36)(37)(38). AFP has been excluded from surveillance and/or diagnostic criteria in guidelines issued in some Western countries, such as the 2005 and 2011 versions of the American Association for the Study of Liver Diseases (AASLD) Guideline, the EASL Guideline, and the National Comprehensive Cancer Network (NCCN) Guideline (22,27,28,39).…”

The Diagnostic Value of Pyruvate Kinase Isoenzyme Type M2 for Biliary Tract Carcinoma. A Systematic Review and Meta-Analysis

“…Meanwhile, no individual and single specific diagnostic tumor biomarkers exist for imaging conflicting results [16,17]. The National Comprehensive Cancer Network (NCCN) guidelines only take carbohydrate antigen 19-9 (CA19-9) as a baseline of continuous surveillance and do not recommend other tumor markers as diagnostic indicators [18]. CA19-9 has a wide variation in sensitivity (50-90%) and specificity (54-98%) [17,[19][20][21][22][23], is falsely elevated in benign biliary diseases, is relieved in biliary obstruction and sepsis, and undetectable in Lewis antigen negative population [17].…”