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Consensus of Minimally Invasive and Multidisciplinary Comprehensive Treatment for Hepatocellular Carcinoma - 2020
Qi-Feng Chen1,2,3, Wang Li1, Simon Chun-Ho Yu4
1Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Insights
Hepatocellular carcinoma (HCC) requires comprehensive, minimally-invasive, multidisciplinary treatment. This guideline emphasizes precise staging, combined therapies for early HCC, and individualized approaches for better patient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Oncology
- Interventional Radiology
Background:
- Hepatocellular carcinoma (HCC) in China is predominantly linked to chronic hepatitis B infection.
- HCC pathology includes rich vascularity, multicentric origins, and early metastasis, indicating a systemic nature from onset.
- Current management necessitates a comprehensive strategy integrating local, organ-level, and systemic treatments.
Purpose of the Study:
- To establish a minimally-invasive and multidisciplinary comprehensive guideline for hepatocellular carcinoma (HCC) management.
- To outline a consensus on diagnosis, staging, and treatment modalities for HCC.
- To promote evidence-based practices for optimizing HCC patient outcomes.
Main Methods:
- Utilizing advanced imaging (hepaticarteriography, CTHA, CTAP, Lp-CT, TACE-CT) for precise lesion detection and staging.
- Recommending TACE combined with ablation or ablation alone as first-line for early/small HCC.
- Classifying infiltrating HCC as a distinct subtype and advocating minimally-invasive treatments for metastatic lymph nodes.
Main Results:
- Proposed multi-level M-staging for personalized treatment and prognosis prediction.
- Identified severe hepatic decompensation as the sole criterion for liver transplantation in HCC.
- Advocated for integrated therapies including bio-immunotherapy, TCM, antiviral, and psychosocial interventions throughout HCC treatment.
Conclusions:
- A minimally-invasive, multidisciplinary approach is crucial for effective HCC management.
- Individualized treatment strategies based on precise staging and subtype classification are recommended.
- Further multicenter randomized controlled trials comparing minimally-invasive therapies with surgery for early/intermediate HCC are encouraged.
Abstract:
In China, the majority of patients with hepatocellular carcinoma (HCC) result from long-term infection of hepatitis B. Pathologically, HCC is characterized by rich blood supply, multicentric origins, early vascular invasion and intrahepatic metastasis. Therefore, HCC is not a local disease but a systemic disease at the beginning of its occurrence. For this reason, a comprehensive treatment strategy should be adopted in the management of HCC, including local treatments (such as surgical resection, radiofrequency ablation, microwave ablation, chemical ablation and cryoablation, etc.), organ-level treatments [such as transcatheter arterial infusion of chemotherapy and transcatheter arterial chemoembolization (TACE)], and systemic treatments (such as immunotherapy, antiviral therapy and molecular targeted therapy, etc.). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive guideline of HCC, focusing on the following eight aspects (1) using hepaticarteriography, CT hepatic arteriography (CTHA), CT arterial portography (CTAP), lipiodol CT (Lp-CT), TACE-CT to find the intrahepatic lesion and make precise staging (2) TACE combined with ablation or ablation as the first choice of treatment for early stage or small HCC, while other therapies are considered only when ablation is not applicable (3) infiltrating HCC should be regarded as an independent subtype of HCC (4) minimally-invasive comprehensive treatment could be adopted in treating metastatic lymph nodes (5) multi-level subdivision of M-staging should be used for individualized treatment and predicting prognosis (6) HCC with severe hepatic decompensation is the only candidate criterion for liver transplantation (7) bio-immunotherapy, traditional Chinese medicine therapy, antiviral therapy, and psychosocial and psychopharmacological interventions should be advocated through the whole course of HCC treatment (8) implementation of multicenter randomized controlled trials of minimally-invasive therapy versus surgery for early and intermediate stage HCC is recommended.
