Practice Guideline
AASLD guidelines for the treatment of hepatocellular carcinoma
Authors
First published: 19 December 2017Full publication history
DOI: 10.1002/hep.29086 View/save citation
Cited by (CrossRef): 27 articles Check for updates
Article has an altmetric score of 6
Potential conflict of interest: Laura M. Kulik is on the advisory board for Gilead, Bayer, Eisai, Salix, and Bristol-Myers Squibb. Richard Finn consults for Pfizer, Bayer, Novartis, Merck, and Bristol-Myers Squibb. Claude B. Sirlin consults for and has received grants from Virtualscopics. Lewis R. Roberts consults for Wako, Medscape, and Axis; advises Tavec and Bayer; is on the speakers' bureau for Onlive; and has received grants from Ariad, BTG, and Gilead. Andrew Zhu consults for Bristol-Myers Squibb, Eisai, Merck, Novartis, Sanofi, and Bayer.
The funding for the development of this Practice Guideline was provided by the American Association for the Study of Liver Diseases.
Abbreviations
AASLD
American Association for the Study of Liver Diseases
AFP
alpha-fetoprotein
CI
confidence interval
CT
computed tomography
DEB-TACE
drug-eluting beads TACE
GRADE
Grading of Recommendation Assessment, Development and Evaluation
HAIC
hepatic arterial infusion chemotherapy
HCC
hepatocellular carcinoma
HBV
hepatitis B virus
HCV
hepatitis C virus
HR
hazard ratio
LRT
local-regional therapy
MELD
Model for End-Stage Liver Disease
mRECIST
modified Response Evaluation Criteria in Solid Tumors
MRI
magnetic resonance imaging
NAFLD
nonalcoholic fatty liver disease
OPTN
Organ Procurement and Transplantation Network
OR
odds ratio
OS
overall survival
PEI
percutaneous ethanol injection
PVT
portal vein thrombosis
RCT
randomized controlled trial
RFA
radiofrequency ablation
RR
relative risk
TACE
transarterial chemoembolization
TACI
transarterial chemoinfusion
TAE
transarterial embolization
TARE
transarterial radioembolization
US
ultrasound
Y90
yttrium-90
Guiding Principles and Objectives
GUIDING PRINCIPLES
This document presents official recommendations of the American Association for the Study of Liver Diseases (AASLD) on the surveillance, diagnosis, and treatment of hepatocellular carcinoma (HCC) occurring in the setting of adults with cirrhosis. Unlike previous AASLD practice guidelines, the current guideline was developed in compliance with the Institute of Medicine standards for trustworthy practice guidelines and uses the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach.[1] Multiple systematic reviews of the literature were conducted to support the recommendations in this practice guideline. An enhanced understanding of the guideline can be obtained by reading the applicable portions of the systematic reviews. In addition, more detailed information may be found in the associated guidance document related to clinically important aspects of HCC that lacked sufficient evidence to warrant a systematic review.
The guideline focuses on a broad spectrum of clinical practice, including surveillance of patients with cirrhosis for HCC, establishing the diagnosis of HCC, and various therapeutic options for the treatment of HCC. To address other issues on HCC such as epidemiology, staging, and additional aspects of diagnosis and treatment, the authors have created a new guidance document that will be published soon and is based upon the previous HCC AASLD guidelines by Bruix and Sherman.[2]
KEY QUESTIONS
The guideline developers from the AASLD identified key questions that health care providers are faced with frequently in the evaluation and management of patients with HCC. These questions were:
Should adults with cirrhosis undergo surveillance for HCC? If so, which surveillance test is best?
Should adults with cirrhosis and suspected HCC undergo diagnostic evaluation with multiphasic computed tomography (CT) or multiphasic magnetic resonance imaging (MRI)?
Should adults with cirrhosis and an indeterminate hepatic nodule undergo a biopsy, repeated imaging, or alternative imaging for the diagnostic evaluation?
Should adults with Child-Pugh class A cirrhosis and early-stage HCC (T1 or T2) be treated with resection or local-regional (LRT) therapy?
Should adults with cirrhosis and HCC that has been resected or ablated successfully undergo adjuvant therapy?
Should adults with cirrhosis awaiting liver transplantation and HCC (T1) be treated or undergo observation?
Should adults with cirrhosis and HCC (Organ Procurement and Transplantation Network [OPTN] T2) awaiting liver transplantation undergo transplantation alone or transplantation with bridging therapy while waiting?
Should adults with cirrhosis awaiting liver transplantation and HCC beyond Milan criteria (T3) undergo transplantation after being down-staged to within Milan criteria?
Should adults with cirrhosis and HCC (T2 or T3, no vascular involvement) who are not candidates for resection or transplantation be treated with transarterial chemoembolization, transarterial radioembolization, or external radiation?
Should adults with Child-Pugh class A/B cirrhosis and advanced HCC with macrovascular invasion and/or metastatic disease be treated with systemic or locoregional therapies or no therapy?
TARGET AUDIENCE
This guideline is intended primarily for health care providers who care for patients with cirrhosis. Additionally, the guideline may inform policy decisions regarding patients with HCC.
潜在的利益冲突：Laura M. Kulik是Gilead，Bayer，Eisai，Salix和Bristol-Myers Squibb的咨询委员会成员。理查德·芬恩为辉瑞，拜耳，诺华，默克和百时美施贵宝咨询。 Claude B. Sirlin咨询并获得Virtualscopics的资助。 Lewis R. Roberts为Wako，Medscape和Axis咨询;建议Tavec和拜耳;在Onlive的演讲厅里;并收到了Ariad，BTG和Gilead的资助。 Andrew Zhu为Bristol-Myers Squibb，Eisai，Merck，Novartis，Sanofi和Bayer提供咨询服务。