Treatment of Hepatocellular Carcinoma
Based on guidelines from the American Association for the Study of Liver Diseases.
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Surveillance
AASLD recommends surveillance of adults with cirrhosis because it improves overall survival.
AASLD suggests surveillance using ultrasound (US), with or without alpha-fetoprotein (AFP), every 6 months.
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.
Diagnosis
AASLD recommends diagnostic evaluation for HCC with either multiphasic CT or multiphasic MRI because of similar diagnostic performance characteristics.
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.
AASLD suggests against routine biopsy of every indeterminate nodule.
Treatment
AASLD suggests that adults with Child-Pugh class A cirrhosis and resectable T1 or T2 HCC undergo resection over radiofrequency ablation.
AASLD suggests against routine use of adjuvant therapy for patients with HCC following successful resection or ablation.
Observation with follow-up imaging over treatment for patients with cirrhosis awaiting liver transplantation who develop T1 HCC is recommended.
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.
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.
AASLD suggests that patients beyond the Milan criteria (T3) should be considered for liver transplantation after successful downstaging into the Milan criteria.
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.
AASLD does not recommend one form of LRT over another.
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.
How strong is the AASLD's recommendation?
