본문 바로가기
KERD
논문KCI 등재

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Taiwan perspective

Chun-Jen Liu|Tung-Hung Su|Chih-Horng Wu|Tsung-Hao Liu|Cheng-Maw Ho
대한간학회 (The korean Association for the Study of the Liver)|2023.04|Clinical and Molecular Hepatology|제29권 제2호|pp. 230-241

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

SurveillanceSurgeryLiver cancerSystemic therapyBarcelona clinic liver cancer

초록

Hepatocellular carcinoma (HCC) is the fourth most common cancer and the second leading cause of cancer-related death in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan developed and updated the guidelines for HCC management in 2020. In clinical practice, we follow these guidelines and the reimbursement policy of the government. In Taiwan, abdominal ultrasonography, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) tests are performed for HCC surveillance every 6 months or every 3 months for high-risk patients. Dynamic computed tomography, magnetic resonance imaging, and contrast-enhanced ultrasound have been recommended for HCC surveillance in extremely high-risk patients or those with poor ultrasonographic visualization results. HCC is usually diagnosed through dynamic imaging, and pathological diagnosis is recommended. Staging of HCC is based on a modified version of the Barcelona Clinic Liver Cancer (BCLC) system, and the HCC management guidelines in Taiwan actively promote curative treatments including surgery and locoregional therapy for BCLC stage B or C patients. Transarterial chemoembolization (TACE), drug-eluting bead TACE, transarterial radioembolization, and hepatic artery infusion chemotherapy may be administered for patients with BCLC stage B or C HCC. Sorafenib and lenvatinib are reimbursed as systemic therapies, and regorafenib and ramucirumab may be reimbursed in cases of sorafenib failure. First-line atezolizumab with bevacizumab is not yet reimbursed but may be administered in clinical practice. Systemic therapy and external beam radiation therapy may be used in specific patients. Early switching to systemic therapy in TACE-refractory patients is a recent paradigm shift in HCC management.

Abstract

Hepatocellular carcinoma (HCC) is the fourth most common cancer and the second leading cause of cancer-related death in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan developed and updated the guidelines for HCC management in 2020. In clinical practice, we follow these guidelines and the reimbursement policy of the government. In Taiwan, abdominal ultrasonography, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) tests are performed for HCC surveillance every 6 months or every 3 months for high-risk patients. Dynamic computed tomography, magnetic resonance imaging, and contrast-enhanced ultrasound have been recommended for HCC surveillance in extremely high-risk patients or those with poor ultrasonographic visualization results. HCC is usually diagnosed through dynamic imaging, and pathological diagnosis is recommended. Staging of HCC is based on a modified version of the Barcelona Clinic Liver Cancer (BCLC) system, and the HCC management guidelines in Taiwan actively promote curative treatments including surgery and locoregional therapy for BCLC stage B or C patients. Transarterial chemoembolization (TACE), drug-eluting bead TACE, transarterial radioembolization, and hepatic artery infusion chemotherapy may be administered for patients with BCLC stage B or C HCC. Sorafenib and lenvatinib are reimbursed as systemic therapies, and regorafenib and ramucirumab may be reimbursed in cases of sorafenib failure. First-line atezolizumab with bevacizumab is not yet reimbursed but may be administered in clinical practice. Systemic therapy and external beam radiation therapy may be used in specific patients. Early switching to systemic therapy in TACE-refractory patients is a recent paradigm shift in HCC management.

참고문헌 (74)

  1. "Cancer registry annual report, 2019, Taiwan"[URL]
  2. Surveillance group, "Management consensus guideline for hepatocellular carcinoma : 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan", J Formos Med Assoc, 117, pp.381~403 (2018)
  3. Chen DS, "Fighting against viral hepatitis : lessons from Taiwan", Hepatology, 54, pp.381~392 (2011)
  4. Chang MH, "Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group", N Engl J Med, 336, pp.1855~1859 (1997)
  5. Liaw YF, "Lamivudine for patients with chronic hepatitis B and advanced liver disease", N Engl J Med, 351, pp.1521~1531 (2004)
  6. Su TH, "Four-year entecavir therapy reduces hepatocellular carcinoma, cirrhotic events and mortality in chronic hepatitis B patients", Liver Int, 36, pp.1755~1764 (2016)
  7. Morgan RL, "Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma : a meta-analysis of observational studies", Ann Intern Med, 158, pp.329~337 (2013)
  8. Wu CY, "Association between nucleoside analogues and risk of hepatitis B virus–related hepatocellular carcinoma recurrence following liver resection", JAMA, 308, pp.1906~1914 (2012)
  9. Hsu YC, "Postoperative peg-interferon plus ribavirin is associated with reduced recurrence of hepatitis C virus-related hepatocellular carcinoma", Hepatology, 58, pp.150~157 (2013)
  10. Liao SH, "Long-term effectiveness of population-wide multifaceted interventions for hepatocellular carcinoma in Taiwan", J Hepatol, 75, pp.132~141 (2021)
  11. Shao YY, "Management consensus guideline for hepatocellular carcinoma : 2020 update on surveillance, diagnosis, and systemic treatment by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan", J Formos Med Assoc, 120, pp.1051~1060 (2021)
  12. Won Sohn, "Impact of nationwide hepatocellular carcinoma surveillance on the prognosis in patients with chronic liver disease", Clinical and Molecular Hepatology, 28(4), pp.851~863 (2022), 대한간학회
  13. Kudo M, "Management of hepatocellular carcinoma in Japan : JSH Consensus statements and recommendations 2021 update", Liver Cancer, 10, pp.181~223 (2021)
  14. Benson AB, "Hepatobiliary cancers, version 2. 2021, NCCN clinical practice guidelines in oncology", J Natl Compr Canc Netw, 19, pp.541~565 (2021)
  15. Kudo M, "JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan", Liver Cancer, 3, pp.458~468 (2014)
  16. Omata M, "AsiaPacific clinical practice guidelines on the management of hepatocellular carcinoma : a 2017 update", Hepatol Int, 11, pp.317~370 (2017)
  17. Kim HD, "Evaluation of early-stage hepatocellular carcinoma by magnetic resonance imaging with gadoxetic acid detects additional lesions and increases overall survival", Gastroenterology, 148, pp.1371~1382 (2015)
  18. Wu CH, "Predictors of changes in preoperative tumor stage between dynamic computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging for hepatocellular carcinoma", J Formos Med Assoc, 121, pp.1550~1559 (2022)
  19. Tang A, "Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI", Expert Rev Gastroenterol Hepatol, 7, pp.269~279 (2013)
  20. Marrero JA, "Diagnosis, staging, and management of hepatocellular carcinoma : 2018 Practice Guidance by the American Association for the Study of Liver Diseases", Hepatology, 68, pp.723~750 (2018)
  21. European Association for the Study of the Liver, "EASL Clinical Practice Guidelines : Management of hepatocellular carcinoma", J Hepatol, 69, pp.182~236 (2018)
  22. Vogel A, "Hepatocellular carcinoma:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up", Ann Oncol, 29(Suppl 4), pp.iv238~iv255 (2018)
  23. Chen LT, "Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with intermediate and advanced", relapsed hepatocellular carcinoma : a TOS-ESMO initiative endorsed by CSCO, ISMPO, JSMO, KSMO, MOS and SSO, 2020, pp.31, 334~351
  24. Rockey DC, "Liver biopsy", Hepatology, 49, pp.1017~1044 (2009)
  25. European Association for The Study of the Liver, "EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
  26. Llovet JM, "Novel advancements in the management of hepatocellular carcinoma in 2008", J Hepatol, 48(Suppl 1), pp.S20~S37 (2008)
  27. Cha C, "Predictors and patterns of recurrence after resection of hepatocellular carcinoma", J Am Coll Surg, 197, pp.753~758 (2003)
  28. Zhang H, "Patterns, timing, and predictors of recurrence after laparoscopic liver resection for hepatocellular carcinoma : results from a high-volume HPB center", Surg Endosc, 36, pp.1215~1223 (2022)
  29. Ayuso C, "Diagnosis and staging of hepatocellular carcinoma(HCC) : current guidelines", Eur J Radiol, 101, pp.72~81 (2018)
  30. Choi SH, "The usefulness of gadoxetic acid-enhanced dynamic magnetic resonance imaging in hepatocellular carcinoma : toward improved staging", Ann Surg Oncol, 22, pp.819~825 (2015)
  31. Bruix J, "Prognostic prediction and treatment strategy in hepatocellular carcinoma", Hepatology, 35, pp.519~524 (2002)
  32. Yau T, "Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma", Gastroenterology, 146, pp.1691~1700 (2014)
  33. "A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators", Hepatology, 28, pp.751~755 (1998)
  34. Tateishi R, "Proposal of a new prognostic model for hepatocellular carcinoma : an analysis of 403 patients", Gut, 54, pp.419~425 (2005)
  35. Kudo M, "Prognostic staging system for hepatocellular carcinoma(CLIP score) : its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score(JIS score)", J Gastroenterol, 38, pp.207~215 (2003)
  36. "2019 cancer statistics of Taiwan"[URL]
  37. Makuuchi M, "Surgery for small liver cancers", Semin Surg Oncol, 9, pp.298~304 (1993)
  38. Wakabayashi G, "Recommendations for laparoscopic liver resection : a report from the second international consensus conference held in Morioka", Ann Surg, 261, pp.619~629 (2015)
  39. Ho CM, "Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy : comparative effectiveness of treatment modalities", Surgery, 151, pp.700~709 (2012)
  40. Llovet JM, "Hepatocellular carcinoma", Nat Rev Dis Primers, 7, pp.6~ (2021)
  41. Cheng HY, "Interval dynamics of transplantability for hepatocellular carcinoma after primary curative resection: risk factors for nontransplantable recurrence", HPB(Oxford), 25, pp.218~228 (2023)
  42. Ho CM, "Survival after treatable hepatocellular carcinoma recurrence in liver recipients : a nationwide cohort analysis", Front Oncol, 10, pp.616094~ (2021)
  43. Bruix J, "Management of hepatocellular carcinoma : an update", Hepatology, 53, pp.1020~1022 (2011)
  44. Crucitti A, "Radiofrequency thermal ablation(RFA)of liver tumors : percutaneous and open surgical approaches", J Exp Clin Cancer Res, 22(4 Suppl), pp.191~195 (2003)
  45. Kim YS, "Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma : analysis of prognostic factors", J Hepatol, 58, pp.89~97 (2013)
  46. Shiina S, "Radiofrequency ablation for hepatocellular carcinoma : 10-year outcome and prognostic factors", Am J Gastroenterol, 107, pp.569~577 (2012)
  47. Song I, "Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites : safety and technical efficacy in 143 patients", Eur Radiol, 19, pp.2630~2640 (2009)
  48. Song KD, "Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound", AJR Am J Roentgenol, 201, pp.1141~1147 (2013)
  49. Teratani T, "Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations", Hepatology, 43, pp.1101~1108 (2006)
  50. Lee LH, "Comparable outcomes of ultrasound versus computed tomography in the guidance of radiofrequency ablation for hepatocellular carcinoma", PLoS One, 12, pp.e0169655~ (2017)
  51. Kim W, "Combination therapy of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for small hepatocellular carcinoma:comparison with TACE or RFA monotherapy", Abdom Radiol(NY), 44, pp.2283~2292 (2019)
  52. Wu CH, "Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma", Hepatol Int, 15, pp.1247~1257 (2021)
  53. Liapi E, "Intra-arterial therapies for hepatocellular carcinoma : where do we stand?", Ann Surg Oncol, 17, pp.1234~1246 (2010)
  54. Chang PY, "Multidisciplinary Taiwan consensus recommendations for the use of DEBDOX-TACE in hepatocellular carcinoma treatment", Liver Cancer, 7, pp.312~322 (2018)
  55. Chow PKH, "SIRveNIB: selective internal radiation therapy versus sorafenib in Asia-Pacific Patients with hepatocellular carcinoma", J Clin Oncol, 36, pp.1913~1921 (2018)
  56. Gordan JD, "Systemic therapy for advanced hepatocellular carcinoma : ASCO guideline", J Clin Oncol, 38, pp.4317~4345 (2020)
  57. Vogel A, "Updated treatment recommendations for hepatocellular carcinoma(HCC)from the ESMO Clinical Practice Guidelines", Ann Oncol, 32, pp.801~805 (2021)
  59. Su TH, "Paradigm shift in the treatment options of hepatocellular carcinoma", Liver Int, 42, pp.2067~2079 (2022)
  60. Lee SW, "Efficacy of lenvatinib and sorafenib in the real-world first-line treatment of advanced-stage hepatocellular carcinoma in a Taiwanese population", J Clin Med, 11, pp.1444~ (2022)
  61. Shao YY, "Bevacizumab and atezolizumab as first-line therapy for advanced hepatocellular carcinoma : A Taiwanese subgroup analysis on efficacy and safety", J Formos Med Assoc, 121, pp.2430~2437 (2022)
  62. Wu CJ, "Lenvatinib plus pembrolizumab for systemic therapy-naïve and-experienced unresectable hepatocellular carcinoma", Cancer Immunol Immunother, 71, pp.2631~2643 (2022)
  63. Cheng AL, "Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma : a phase III randomised, double-blind, placebo-controlled trial", Lancet Oncol, 10, pp.25~34 (2009)
  64. Kudo M, "Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma : a randomised phase 3non-inferiority trial", Lancet, 391, pp.1163~1173 (2018)
  65. El-Khoueiry AB, "Nivolumab in patients with advanced hepatocellular carcinoma(CheckMate 040) : an open-label, non-comparative, phase 1", 2 dose escalation and expansion trial, 2017, pp.389, 2492~2502
  66. Finn RS, "Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma", N Engl J Med, 382, pp.1894~1905 (2020)
  67. Lee MS, "Atezolizumab with or without bevacizumab in unresectable hepatocellular carcinoma (GO30140):an open-label, multicentre, phase 1b study", Lancet Oncol, 21, pp.808~820 (2020)
  68. Qin S, "Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil", leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia, 2013, pp.31, 3501~3508
  69. Lin CC, "Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein thrombosis : impact of early response to 4 weeks of treatment", Liver Cancer, 4, pp.228~240 (2015)
  70. Shao YY, "A pilot study of hepatic arterial infusion of chemotherapy for patients with advanced hepatocellular carcinoma who have failed anti-angiogenic therapy", Liver Int, 33, pp.1413~1419 (2013)
  71. He M, "Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion : a randomized clinical trial", JAMA Oncol, 5, pp.953~960 (2019)
  72. Yeo W, "A randomized phase III study of doxorubicin versus cisplatin", interferon alpha-2b, fluorouracil(PIAF)combination chemotherapy for unresectable hepatocellular carcinoma, pp.J Natl Cancer Inst, 2005[DOI]
  73. Korean Liver Cancer Association (KLCA), "2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma", Clinical and Molecular Hepatology, 28(4), pp.583~705 (2022), 대한간학회
  74. Reig M, "BCLC strategy for prognosis prediction and treatment recommendation : The 2022 update", J Hepatol, 76, pp.681~693 (2022)

관련 논문AI추천

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Hong Kong perspectiveLung-Yi Mak, Man-Fung Yuen, Rex Wan-Hin Hui, Tan-To Cheung, Victor Ho-Fun Lee, Wai-Kay Seto대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제2호Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspectiveDiyang Xie, Jia Fan, Jian Zhou, Jieyi Shi, Qiang Gao대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제2호Taiwan liver cancer association management consensus guidelines for intermediate-stage hepatocellular carcinomaChao-Hung Hung, Chia-Yen Dai, Chien-An Liu, Chien-Hung Chen, Chien-Wei Su, Ching-Wei Chang, Chin-Tsung Ting, Gar-Yang Chau, Hsueh-Chou Lai, Hung-Wei Wang, I-Cheng Lee, Kuan-Yang Chen, Li-Tzong Chen, Ming-Chih Ho, Pi-Yi Chang, Po-Chin Liang, Shi-Ming Lin, Teng-Yu Lee, Tsung-Jung Lin, Wei-Chen Lee, Wei Teng, Yi-Hsiang Huang, Ying-Chun Shen, Yi-Ping Hung대한간학회 · Clinical and Molecular Hepatology2025 · 제31권 제4호Clinical practice guideline and real-life practice in hepatocellular carcinoma: A Korean perspectiveDong Ho Hyun, Dong Hyun Sinn, Jeong Il Yu, Jong Man Kim, Jung Yong Hong, Min Woo Lee, Moon Seok Choi, Myung Ji Goh대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제2호Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Japanese perspectiveHideki Iwamoto, Hironori Koga, Hiroyuki Suzuki, Masahito Nakano, Shigeo Shimose, Takumi Kawaguchi대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제2호Overview of Asian clinical practice guidelines for the management of hepatocellular carcinoma: An Asian perspective comparisonBo Hyun Kim, Joong-Won Park, Yuri Cho대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제2호

이 간행물의 다른 논문 (53건)

Congratulatory remarksSi Hyun Baepp. 1-1Special thanksSeung Up Kimpp. 4-4MAFLD: How is it different from NAFLD?Ming-Hua Zheng, Jacob George, Cameron Gofton, Yadhavan Upendranpp. 17-31Global incidence and prevalence of nonalcoholic fatty liver diseaseEunice Tan, Mark D. Muthiah, Cheng Han Ng, Margaret LP Teng, Kai En Chan, Darren JH Tan, Wen Hui Lim, Ju Dong Yang, Daniel Q. Huangpp. 32-42Nonalcoholic fatty liver disease and non-liver comorbiditiesRichie Manikat, Mindie H. Nguyenpp. 86-102
원문 보기