2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma.
Bottom Line: In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies.Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions.This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.
The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.
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Mentions: Liver cancer is the main cause of death of Korean men in their 50s. According to the National Statistics Office of Korea, 22.5 people (male, 33.7; female, 11.3) per 100,000 population die annually from liver cancer. While the most frequent cause of death in people after the age of 40 is malignancy, liver cancer is the top-ranked cause of death in people in their 40s and 50s.10 According to a recent report of 10 principal cancers, shows that the 5-year cancer relative survival rates for liver cancer were 10.7%, 13.2%, 20.2%, 27.3%, and 28.6% from 1993–1995, 1996–2000, 2001–2005, 2006–2010, and 2007–2011, respectively, showing consistent improvement (Fig. 2). However, the prognosis of liver cancer remains very poor compared to the 66.3% 5-year relative survival rates of all cancer patients from 2007 to 2011 in Korea.7,8 The prognosis of HCC is closely related to liver function. A report from Europe stated that a few patients excluded from curative treatment study (i.e., liver resection, liver transplantation [LT], and percutaneous ethanol injection) showed a 3-year survival rate of 28% without any treatment for HCC.11 However, this could be considered to be a result of selection bias. In Korea, according to the 2003–2005 randomized registration of HCC (n=4,521), modified Union for International Cancer Control (mUICC) stages I, II, III, IVa, and IVb were 10.7%, 33.4%, 27.7%, 10.3%, and 7.9%, respectively; the 3-/5-year survival rates in these stages were 62.3%/52.0%, 48.1%/36.0%, 22.3%/15.5%, 8.0%/6.5%, and 8.0%/6.1%, respectively.12 A recent single-center cohort study reports that 8.9%, 29.6%, 24.8%, 23.1%, and 13.6% of 1,972 patients with HCC from 2004 to 2009 were mUICC stage I, II, III, IVa, and IVb, respectively.13 The 5-year survival rates in stages I, II, III, IVa, and IVb were 71.1%, 59.8%, 25.0%, 4.6%, and 2.1%, respectively, showing improvement in overall survival rates compared with the previous 2000–2003 cohort study. Improved survival rates in hepatitis B-related advanced HCC highlights the importance of antiviral therapy for hepatitis B-positive patients.13 The risk factors for HCC are relatively well known14,15 and include chronic hepatitis B/C, liver cirrhosis, alcoholic liver disease, obesity- and fatty liver disease-related diabetes mellitus,15,16 and aflatoxin.17 In Korea, one study reports that the underlying liver diseases of HCC patients included hepatitis B (72.3%), hepatitis C (11.6%), alcoholic liver disease in (10.4%), and non-B non-C hepatitis (0.7%).12 Another study reports that 74.6% of HCC patients were positive for hepatitis B virus (HBV), 9.3% were positive for hepatitis C virus (HCV), 7.4% were long-term alcohol abusers, and 8.7% had unidentified causes (probably metabolic liver disease).13 HCC develops in 1%–4% of cirrhotic patients annually18 and eventually develops in approximately one-third of cirrhotic patients.19 In Korea, the number of carriers of hepatitis B decreased markedly because of hepatitis B vaccination and prevention services in vertical transmission. Although antiviral therapy for chronic hepatitis B and C is expected to further decrease the incidence of HCC, metabolic liver disease may increase as a cause of HCC in the future.