Treatment of Hepatocellular Carcinoma
Based on guidelines from the American Association for the Study of Liver Diseases.
summary by
Surveillance
Surveillance
AASLD recommends surveillance of adults with cirrhosis because it improves overall survival.
Strong recommendation
Moderate quality evidence
AASLD suggests surveillance using ultrasound (US), with or without alpha-fetoprotein (AFP), every 6 months.
Conditional recommendation
Low quality evidence
AASLD suggests not performing surveillance of patients with Child-Pugh class C cirrhosis unless they are on the transplant waiting list, given low anticipated survival for these patients.
Conditional recommendation
Low quality evidence
Diagnosis
Imaging
AASLD recommends diagnostic evaluation for HCC with either multiphasic CT or multiphasic MRI because of similar diagnostic performance characteristics.
Strong recommendation
Low quality evidence
Indeterminate Nodule
AASLD suggests several options for diagnosis in patients with cirrhosis and an indeterminate nodule, including follow-up imaging, imaging with an alternative modality or alternative contrast agent, or biopsy, but cannot recommend one option over the other.
Conditional recommendation
Very low quality evidence
AASLD suggests against routine biopsy of every indeterminate nodule.
Conditional recommendation
Very low quality evidence
Treatment
Early-stage HCC
AASLD suggests that adults with Child-Pugh class A cirrhosis and resectable T1 or T2 HCC undergo resection over radiofrequency ablation.
Conditional recommendation
Moderate quality evidence
Adjuvant Therapy
AASLD suggests against routine use of adjuvant therapy for patients with HCC following successful resection or ablation.
Conditional recommendation
Low quality evidence
T1 HCC and Transplant
Observation with follow-up imaging over treatment for patients with cirrhosis awaiting liver transplantation who develop T1 HCC is recommended.
Conditional recommendation
Very low quality evidence
T2 HCC and Transplant
AASLD suggests bridging to transplant in patients listed for liver transplantation within OPTN T2 (Milan) criteria to decrease progression of disease and subsequent dropout from the waiting list.
Conditional recommendation
Very low quality evidence
AASLD does not recommend one form of liver-directed therapy over another for the purposes of bridging to liver transplantation for patients within OPTN T2 (Milan) criteria.
Conditional recommendation
Very low quality evidence
T3+ HCC
AASLD suggests that patients beyond the Milan criteria (T3) should be considered for liver transplantation after successful downstaging into the Milan criteria.
Conditional recommendation
Very low quality evidence
Logoregional Therapy (LRT)
AASLD recommends LRT over no treatment in adults with cirrhosis and HCC (T2 or T3, no vascular involvement) who are not candidates for resection or transplantation.
Strong recommendation
Very low quality evidence
AASLD does not recommend one form of LRT over another.
Conditional recommendation
Very low quality evidence
Advanced Disease
AASLD recommends use of systemic therapy over no therapy for patients with Child-Pugh class A cirrhosis or well-selected patients with Child-Pugh class B cirrhosis plus advanced HCC with macrovascular invasion and/or metastatic disease.
Strong recommendation
Moderate quality evidence
What do the icons mean?
How strong is the AASLD's recommendation?
Strong recommendation
Intervention's desirable effects clearly outweigh undesirable effects.Moderate recommendation
Further research likely to impact confidence in estimate of effect.
Conditional recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.Weak recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.
High quality evidence
Further research unlikely to change guideline authors' confidence in estimate of effect.
Moderate quality evidence
Further research likely to impact confidence in estimate of effect.Low quality evidence
Further research expected to have important impact in confidence in estimate of effect.Very low quality evidence
Effect is very uncertain.Literature
