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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Treatment of Hepatocellular Carcinoma (beta)

    Based on guidelines from the American Association for the Study of Liver Diseases.

    Strength
    Strong recommendation
    Moderate recommendation
    Conditional recommendation
    Weak recommendation
    Evidence
    High quality evidence
    Moderate quality evidence
    Low quality evidence
    Very low quality evidence

    Surveillance

    Surveillance
    1. AASLD recommends surveillance of adults with cirrhosis because it improves overall survival.
    2. AASLD suggests surveillance using ultrasound (US), with or without alpha-fetoprotein (AFP), every 6 months.
    3. 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

    Imaging
    1. AASLD recommends diagnostic evaluation for HCC with either multiphasic CT or multiphasic MRI because of similar diagnostic performance characteristics.
    Indeterminate Nodule
    1. 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.
    2. AASLD suggests against routine biopsy of every indeterminate nodule.

    Treatment

    Early-stage HCC
    1. AASLD suggests that adults with Child-Pugh class A cirrhosis and resectable T1 or T2 HCC undergo resection over radiofrequency ablation.
    Adjuvant Therapy
    1. AASLD suggests against routine use of adjuvant therapy for patients with HCC following successful resection or ablation.
    T1 HCC and Transplant
    1. Observation with follow-up imaging over treatment for patients with cirrhosis awaiting liver transplantation who develop T1 HCC is recommended.
    T2 HCC and Transplant
    1. 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.
    2. 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.
    T3+ HCC
    1. AASLD suggests that patients beyond the Milan criteria (T3) should be considered for liver transplantation after successful downstaging into the Milan criteria.
    Logoregional Therapy (LRT)
    1. 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.
    2. AASLD does not recommend one form of LRT over another.
    Advanced Disease
    1. 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.
    What do the icons mean?  
    Research PaperHeimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358-380.