Overview of Asian clinical practice guidelines for the management of hepatocellular carcinoma: An Asian perspective comparison

Abstract

Hepatocellular carcinoma (HCC) is highly prevalent and the third most common cause of cancer-related death in Asia. In contrast to the West, the main etiology of HCC in many Asian countries except Japan is chronic hepatitis B virus infection. Differences in the major causes of HCC lead to significant clinical and treatment differences. This review summarizes and compares guidelines on managing HCC from China, Hong Kong, Taiwan, Japan, and South Korea. From oncology and socio-economic perspectives, factors such as underlying diseases, staging methods, government policies, insurance coverage, and medical resources contribute to varying treatment strategies among countries. Furthermore, the differences in each guideline are fundamentally caused by the lack of incontrovertible medical evidence, and even existing results of clinical trials can be interpreted differently. This review will provide a complete overview of the current Asian guidelines for HCC in recommendations and in practice.

SGLT2i impact on HCC incidence in patients with fatty liver disease and diabetes: a nation-wide cohort study in South Korea

“…This difference is attributed not only to viral infection but also to variations in HCC screening strategies for both cohorts. CVH is a well-known risk factor for HCC, and it is recommended by various expert groups that patients with CVH should undergo biannual HCC screening 27 – 29 . On the other hand, in patients without CVH or liver cirrhosis, regular HCC screening is not recommended.…”

Chemoembolization combined with radiofrequency ablation is the best option for the local treatment of early hepatocellular carcinoma?

“…A 3-cm tumor size is a crucial number in treatment triage, and most Asian guidelines recommend local ablation for HCCs ≤3 cm. 5 Similarly, radiofrequency ablation is seldom performed in patients with tumors >3 cm at our institute. However, the inclusion criterion in this study was a tumor size of <5 cm.…”

Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives

“…Trans-arterial therapies still represent the most commonly used approach to HCC, and conventional TACE (cTACE) is the most widely used. According to most Asian guidelines, in cases of intermediate HCC without significant vascular invasion or extrahepatic dissemination, TACE is the recommended course of therapy [30]. The main reasons are related to the possible presence of additional HCC nodules requiring diagnostic angiography (28%), difficult or complex anatomical tumor location (17%), high surgical risk (12%), patient's refusal to surgery or ablation (10%), and risk of post-treatment liver failure [31].…”