Critical appraisal of Chinese 2017 guideline on the management of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the fourth most common and the third most lethal cancer in China. An updated version of consensus-based recommendations on the management of HCC has been recently published by a multidisciplinary group of Chinese experts including liver surgeons, hepatic oncologists, radiologists and pathologists. Major changes have been made to the diagnostic criteria. In addition to dynamic multi-detector computed tomography (CT) and magnetic resonance imaging (MRI), gadoxetic acid-enhanced MRI and contrast-enhanced ultrasound (CEUS) are added to the diagnostic imaging tests. Meanwhile, positive alpha-fetoprotein (AFP) no longer functions as a confirmatory test in nodules of 1–2 cm in diameter. For patients with chronic hepatitis B/C or cirrhosis of any cause, nodules more than 2 cm can be diagnosed with HCC based on typical features on one of the four imaging techniques, whereas nodules ≤2 cm need two typical imaging findings for diagnosis. Based on the increased evidences and clinical practices, a new staging system and treatment algorithm has been developed to be more comprehensible and suitable for use in China. Surgical resection, transplantation and local regional therapies (LRTs) are indicated for more progressed HCC in terms of tumor burden and for more diseased patients in terms of liver function in China than in western centers. Laparoscopic liver resections (LLRs) are not restricted by intrahepatic tumor locations and the volume of resected liver, provided lesions generally ≤10 cm. Future efforts involving prospective studies are essential to confirm the validity of the current Chinese guidelines for HCC.