Chinese expert consensus on refined diagnosis, treatment, and management of advanced primary liver cancer (2023 edition)^{☆, ☆☆}

Abstract

Hepatocellular carcinoma (HCC), commonly known as primary liver cancer, is a major cause of malignant tumors and cancer-related deaths in China, accounting for approximately 85% of all cancer cases in the country. Several guidelines have been used to diagnose and treat liver cancer. However, these guidelines provide a broad definition for classifying advanced liver cancer, with an emphasis on a singular approach, without considering treatment options for individual patients. Therefore, it is necessary to establish a comprehensive and practical expert consensus, specifically for China, to enhance the diagnosis and treatment of HCC using the Delphi method. The classification criteria were refined for Chinese patients with HCC, and the corresponding optimal treatment regimen recommendations were developed. These recommendations took into account various factors, including tumor characteristics, vascular tumor thrombus grade, distant metastasis, liver function status, portal hypertension, and the hepatitis B virus replication status of patients with primary HCC, along with treatment prognosis. The findings and recommendations provide detailed, scientific, and reasonable individualized diagnosis and treatment strategies for clinicians.

Keywords

Hepatocellular carcinoma (HCC) / Targeted therapy / Immunotherapy / Refined diagnosis and treatment / Expert consensus

Authors’ contributions

Xiufeng Liu, Feng Xia, and Yue Chen contributed equally to this work. Xiufeng Liu, Feng Xia, Yue Chen, Huichuan Sun, Zhengqiang Yang, Bo Chen, Ming Zhao, Xinyu Bi, Tao Peng, and Zhiwen Luo contributed to draft writing. Xiufeng Liu, Feng Xia, Yue Chen, Zhiwen Luo, and Aizier Ainiwaer provided technical and material support. Fusheng Wang and Yinying Lu contributed to the conception and design. Other experts participated in consensus discussion and suggestions. All authors read and approved the final manuscript.

Declaration of competing interest

The authors declare that there is no conflicts of interest.

List of experts (arranged in alphabetical order by the last name)

Aizier Ainiwaer (Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China), Xinyu Bi (Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chi-nese Academy of Medical Sciences and Peking Union Medical Col-lege, Beijing, China), Dan Cao (Abdominal Oncology Ward, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China), Bo Chen (Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China), Rongxin Chen (Key Laboratory of Carcinogenesis and Cancer Invasion, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China), Yue Chen (Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China), Jiamin Cheng (Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China), Shuangsuo Dang (Department of Infectious Dis-eases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China), Jie Gao (Department of Hepatobiliary sur-gery, Peking University People's Hospital, Beijing, China), Yanhang Gao (Department of Hepatology, The First Hospital of Jilin Univer-sity, Jilin University, Changchun, Jilin, China), Yufeng Gao (Depart-ment of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China), Xinlei Gong (Department of Medical Oncology, Bayi Hospital Affiliated to Nanjing Chinese Medical University, Nanjing, Jiangsu, China), Yabing Guo (State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangz-hou, Guangdong, China), Yarong Guo (Department of Oncology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China), Zhen Huang (Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Can-cer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China), Long Jin (Depart-ment of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China), Haiyang Li (Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medi-cal University, Guiyang, Guizhou, China), Jianjun Li (The First Affiliated Hospital of the Army Medical University, Chongqing, China), Junhe Li (Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China), Junyi Li (Department of Infectious Diseases, The Third People's Hospital of Kunming City, Yunnan, China), Ke Li (Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China), Qiu Li (Division of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China), Wei Li (No.2 People's Hospital of Fuyang City, Fuyang, Anhui, China), Wenhua Li (The Third People's Hospital of Taiyuan, Taiyuan, Shanxi, China), Zhiwei Li (Department of hepatobiliary surgery, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China), Ying Liu (Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China), Xiufeng Liu (Department of Medical Oncology, Bayi Hospital Affiliated to Nanjing Chinese Medical University, Nanjing, Jiangsu, China), Jun Lu (Hepatology and Cancer Biotherapy Ward, Beijing Youan Hospital, Capital Medical University, Beijing, China), Shichun Lu (Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hep-atobiliary Surgery, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army Medical School, Chinese People's Liberation Army General Hospital, Beijing, China), Yinying Lu (Comprehensive Liver Cancer Center, The Fifth Medical Center of PLA General Hospital, Beijing, China), Wei Lu (Tianjin Medical University Cancer Institute & Hospital, Tianjin, China), Zhiwen Luo (Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chi-nese Academy of Medical Sciences and Peking Union Medical Col-lege, Beijing, China), Fanping Meng (Senior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hos-pital, Beijing, China), Yuemin Nan (Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China), Qin Ning (Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical Col-lege, Huazhong University of Science and Technology, Wuhan, Hubei, China), Zuoxing Niu (Shandong Cancer Hospital and Insti-tute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China), Shifang Peng (Xiangya Hospital of Central-South University, Changsha, Hunan, China), Tao Peng (Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China), Xiujuan Qu (Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China), Jie Shen (Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, China), Tianqiang Song (Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China), Huichuan Sun (Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China), Jian Sun (State Key Laboratory of Organ Failure Research, Guang-dong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China), Fusheng Wang (Senior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing, China), Shuai Wang (Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China), Weihu Wang (Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China), Wentao Wang (Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China), Xin Wang (Department of Abdominal Oncology/Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China), Lai Wei (Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China), Jianbing Wu (Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China), Feng Xia (Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China), Yong Xia (Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, The Second Military Medical University, Shanghai, China), Qing Xie (Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China), Long Xu (Department of Gastroenter-ology and Hepatology, Shenzhen University General Hospital, Shenzhen, Guangdong, China), Yongfeng Yang (The Second Hospital of Nanjing, Teaching Hospital of Southeast University, Nanjing, Jiangsu, China), Zhengqiang Yang (Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China), Jieer Ying (Department of Hepato-Pancreato-Biliary & Gastric Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China), Chaohui Yu (Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hang-zhou, Zhejiang, China), Hongjiang Yu (Inner Mongolia Tongliao City Hospital, Tongliao, Inner Mongolia, China), Lingxiang Yu (Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China), Zhengang Yuan (Department of Oncology, Eastern Hepatobiliary Surgery Hospital, The Second Military Med-ical University, Shanghai, China), Shan Zeng (Department of Oncology, Xiangya Hospital of Central-South University, Changsha, Hunan, China), Jing Zhang (The Third Unit, Department of Hep-atology, Beijing Youan Hospital, Capital Medical University, Beijing, China), Jingdong Zhang (Medical Oncology Department of Gastro-intestinal Cancer, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, Liaoning, China), Lan Zhang (Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China), Haitao Zhao (Department of Liver Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China), Hong Zhao (Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China), Ming Zhao (Department of Mini-mally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China), Shi Zuo (Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China).

Acknowledgements

This work was funded by the National Natural Science Foun-dation of China (No. 82272956).

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