Diagnosis and Stage-Dependent Treatment of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is currently the second most common cause of cancer-related death worldwide, with the majority of all cases of HCC found in the Asia-Pacific region. Indeed, HCC is one of the leading public health challenges in the Asia-Pacific region. The Asian Pacific Association for the Study of the Liver (APASL) HCC guideline was published in 2010, and it has been the oldest of the major guidelines to date. The ‘Toward Revision of the APASL HCC Guideline’ meeting was held at the 25th annual conference of the APASL, Tokyo, Japan, on 23rd February 2016. The new guideline is evidence-based and is generally accepted in the Asia-Pacific region, which has a diverse range of medical environments. This latest guideline includes two variations of diagnostic algorithms based on the use of multi-modalities, mainly gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS), and only using dynamic computed tomography (CT) or MRI. This is because this guideline focusses on the universal usage in the Asia-Pacific region. The updated treatment algorithm has several unique points. Firstly, recommended treatments are separated into ‘standard treatment’ and ‘treatment being widely performed’ in the Asia-Pacific region. Secondly, the indication of resection is not defined and decided in discussions between surgeon and hepatologist in Child–Pugh classified A and B patients without extrahepatic metastasis. Although these ideas seem to go against the era of evidence-based medicine, we believe that this latest treatment algorithm gives priority to HCC patients in the Asia-Pacific region, with a wide variety of medical environments. The latest APASL HCC guideline is going to be published in several months.