Posted: Wednesday, May 24, 2023
Joong-Won Park, MD, PhD, of National Cancer Center, Goyang, Korea, and colleagues compared the clinical practice guidelines for the management of hepatocellular carcinoma in Asia, with a focus on China, Hong Kong, Taiwan, Japan, and South Korea. They considered oncologic and socioeconomic factors such as government policies, insurance coverage, and access to medical resources as well as clinical practices such as surveillance strategies, diagnostic modalities, staging systems, treatment modalities, and locoregional and surgical treatment approaches. Their findings were published in Clinical and Molecular Hepatology.
The investigators found significant differences in the management of the disease in different Asian countries. For example, Korean guidelines adopt the modified Union for International Cancer Control (UICC) staging as the primary system; however, the Barcelona Clinic Liver Cancer (BCLC) staging system and American Joint Committee on Cancer (AJCC)/UICC TNM staging system also serve as complementary systems. Also, liver transplantation is an ideal treatment for patients with hepatocellular carcinoma and liver cirrhosis. However, organ shortage often precludes liver transplantation, and most Asian guidelines stated living donor liver transplantation.
In addition, it was assumed that immune checkpoint inhibitor therapy for hepatocellular carcinoma would be disadvantageous, since the liver is an immune-tolerant organ. However, recently, atezolizumab plus bevacizumab and durvalumab plus tremelimumab have succeeded in clinical trials, making them available for patients with advanced disease in some countries and recommended in the most consistently universal guidelines.
Overall, multidisciplinary efforts to optimize treatment and improve clinical trial designs are necessary to enhance patient outcomes, and a better understanding of oncologic backgrounds and socioeconomic resources may improve multinational clinical trials. Consensus-based recommendations are influenced by socioeconomic policies, medical resources, leading physicians, compliance of patients, and culture. Therefore, the authors believe it is critical to acknowledge these influences when understanding the recommendations.
Disclosure: The study authors reported no conflicts of interest.
Clinical and Molecular Hepatology