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Clinical practice guidelines and real-life practice on hepatocellular carcinoma: the Hong Kong perspective
Rex Wan-Hin Hui1, Lung-Yi Mak1,2, Tan-To Cheung2,3
1Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong.
Insights
Hepatocellular carcinoma (HCC) management in Hong Kong follows local guidelines for surveillance and treatment, aligning with international practices for diagnosis and staging. Real-world application shows adherence, though individualization and center variations exist.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) presents a significant public health challenge in Hong Kong.
- Chronic hepatitis B is the predominant etiological factor for HCC in the region.
- Extensive local expertise in HCC management has been developed due to a high patient caseload.
Purpose of the Study:
- To summarize current local guidelines and real-life practices for Hepatocellular carcinoma (HCC) management in Hong Kong.
- To provide an overview of HCC surveillance, diagnosis, staging, and treatment strategies.
- To highlight the alignment between Hong Kong's HCC guidelines and clinical practice.
Main Methods:
- Review of local Hepatocellular carcinoma (HCC) guidelines.
- Analysis of clinical practice patterns in HCC management.
- Comparison of local guidelines with international staging and treatment systems.
Main Results:
- Local guidelines recommend liver ultrasound and alpha-fetoprotein for HCC surveillance in at-risk patients, with consistent adherence in practice.
- While not explicitly in local guidelines, HCC diagnosis follows regional standards using imaging without mandatory histology.
- Local guidelines advocate for the Hong Kong Liver Cancer Staging system, though Barcelona Clinic Liver Cancer and Tumor-Node-Metastasis staging systems are also commonly used.
- Treatment algorithms encompass resection, ablation, transplant, TACE, TARE, SBRT, targeted therapy, and immunotherapy, with real-world choices generally aligning with guidelines.
- Individualized treatment protocols and variations in therapy availability across centers are noted.
Conclusions:
- Hong Kong's HCC guidelines are tailored to local expertise and patient demographics, offering practical approaches for routine care.
- The guidelines are current but require regular updates to reflect advancements in HCC management.
- There is a strong correlation between established guidelines and actual clinical practice in HCC treatment within Hong Kong.
Abstract:
Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.
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