Ajith K Siriwardena, Eduard Jonas, Glenn Bonney, Shridhar Iyer, John Primrose, Rafik Filobbos, Paleswan Lakhey, T P Kingham, Mehan Siriwardhane, Elijah Dixon, Mariano E Gimenez, Rohan Jeyarajah, Jose M Ramia, Javier Lendoire, Tian Q Song, Francesco Lancellotti, Deirdre Kruger, Ewen M Harrison, Gabriel Abellay, Oscar Imventarza, Martin I Prince, Shailesh V Shrikhande, Ramesh Bhandari, Arinda Dharmapala, Rohan Siriwardana, Ivan C Martinez, Sharon Barker, Louise M Finch, Stefan Stattner, Aiste K Gulla, Mustafa Kerem, Carlijn I Buis, Anita Balakrishnan, Steven J Wigmore, David Leggett, Felipe Comibra, Roeland de Wilde, Alejandro Serrablo, Avinash Supe, Nuru Bayramov, Anya Adair, Frederik Berrevoet, Manuel Maglione, William Jarnagin, Norihiro Kokudo, Krishnakumar Madhavan, Martin Smith, Rene Adam
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引用次数: 0
Abstract
Background: Current guidelines for the management of patients with HCC are predominantly focused on well-resourced healthcare systems. In 2024, the IHPBA Legacy committee initiated a process to develop global resource-sensitive guidelines for the management of HCC.
Methods: An IHPBA global guideline group produced and circulated statements on the management of HCC from diagnosis to treatment, discussed these in online webinars and generated guidelines. This document focuses on the diagnosis and management of patients with HCC in resource-constrained healthcare settings.
Results: Initial diagnosis by ultrasound is supported by cross-sectional imaging. Alfa-feto protein and assessment of liver synthetic function are recommended at diagnosis. Lesion biopsy is not mandated. Liver resection is the recommended treatment of choice for single HCC in patients with preserved liver function and up to 3 lesions ≤3 cm. Radiofrequency and microwave are regarded as equivalent and can be used if resection is not available. Ethanol injection can be used if thermal ablation is not available but should be restricted to small lesions. TACE and TAE can be used for intermediate stage disease. Atezolizumab/bevacizumab combination is recommended as first line systemic therapy with sorafenib and Lenvatinib being recommended if first line is not an option. Advice for the care of the patient with advanced or terminal disease is provided.
Conclusions: This document provides resource-sensitive HCC guidelines that prioritise feasibility, maximise benefit, and reduce default reliance on best supportive care alone and are produced for the IHPBA by discussion with the global community of IHPBA.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).
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