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[Practice guideline for diagnosis and treatment of hepatocellular carcinoma]
1Korean Liver Cancer Study Group, Korea.
Insights
This practice guideline provides a consensus for diagnosing and treating Hepatocellular Carcinoma (HCC) in Korea. It emphasizes early detection and tailored treatment strategies for advanced stages, aiming to improve patient outcomes.
Area of Science:
- Oncology
- Hepatology
- Gastroenterology
Context:
- Hepatocellular carcinoma (HCC) is a significant health concern in Korea, with over 10,000 annual cases.
- Hepatitis B virus (HBV) is a primary cause, but alcoholic liver disease is an increasing trend.
- Late diagnosis contributes to a low 5-year survival rate of 9.6% for HCC.
Purpose:
- To develop a comprehensive practice guideline for the diagnosis and treatment of HCC in Korea.
- To establish consensus among experts based on scientific evidence and the Korean medico-social context.
- To provide guidance for a nationwide surveillance program targeting high-risk groups.
Summary:
- The guideline identifies diagnostic criteria and staging for HCC, differentiating between operable and inoperable tumors.
- Treatment strategies are outlined, including surgical resection, liver transplantation, chemoembolization, local ablation, radiation therapy, and chemotherapy.
- Decisions consider tumor operability, resectability, liver function (Child-Pugh score), and tumor stage (UICC).
Impact:
- Expected to aid in the clinical management of HCC patients in Korea.
- Aims to improve early diagnosis and treatment efficacy for Hepatocellular Carcinoma.
- Facilitates research by providing a standardized framework for HCC patient care.
Background/Aims:
Hepatocellular carcinoma (HCC) is the 3rd most common cancer. The annual incidence is over 10,000 cases in Korea. While hepatitis B virus is major cause of Korean HCC, the impact of alcoholic liver disease is a rising trend. The 5-year survival rate of HCC is only 9.6%, mainly due late diagnosis, tumor biology and underlying chronic liver diseases. Because almost eighty percent of HCC is diagnosed in late, not early stages, a nationwide surveillance program to screen high risk groups (HBV or HCV carriers or liver cirrhosis, over 40 years old) was launched last year and a practice guideline, with special emphasis on advanced stage HCC was formulated.
Methods:
Forty-five experts from KLCSG and the National Cancer Center participated in a special committee to develop a practice guideline for HCC. Based on scientific evidence, the consensus was made for diagnosis and treatment strategy after considering the medico-social situation in Korea.
Results:
Required and optional tests and clinical (non-invasive) diagnosis criteria for HCC are identified. The first decision, based on both Child-Pugh score and modified UICC tumor staging, is to determine operability. The second decision, to determine resectability, is based on localization of the tumor and residual liver function. Chemoembolization or local ablation therapy is allowed for resectable tumors in certain conditions, such as at borderline risk or non-invasively diagnosed. Unresectable tumors are classified into either a group with inadequate residual liver functions or the another group with extensive or macrovascular invasion or distant metastases. Indications of liver transplantation, chemoembolization, local ablation, radiation therapy and chemotherapy for unresectable HCC are presented.
Conclusions:
This guideline is expected to be useful for clinical management of, and research for HCC patients.
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