Advanced search
Publication Cover
Journal of Hepatocellular Carcinoma Volume 10, 2023 - Issue
Submit an article Journal homepage
526
Views
0
CrossRef citations to date
0
Altmetric
REVIEW

Egyptian Society of Liver Cancer Recommendation Guidelines for the Management of Hepatocellular Carcinoma

Ashraf Omar1 Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence[email protected]
View further author information
,
Ahmed Kaseb2 Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USAView further author information
,
Tamer Elbaz1 Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Mohamed El-Kassas3 Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, EgyptORCID Iconhttps://orcid.org/0000-0002-3396-6894View further author information
ORCID Icon,
Amr El Fouly3 Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, EgyptView further author information
,
Abdel Fatah Hanno4 Department of Gastroenterology, Faculty of Medicine, Alexandria University, Alexandria, EgyptView further author information
,
Ahmed El Dorry5 Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Ahmed Hosni6 Department of Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Amr Helmy7 Department of Surgery, National Liver Institute Menoufia University, Menoufia, EgyptView further author information
,
Amr S Saad8 Department of Oncology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Ashwaq Alolayan9 Department of Oncology, National Guard Hospital, Riyadh, Saudi ArabiaView further author information
,
Basem Elsayed Eysa10 Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo, EgyptView further author information
,
Emad Hamada11 Department of Oncology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Hamdy Azim11 Department of Oncology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Hany Khattab12 Department of Pathology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Hesham Elghazaly8 Department of Oncology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Hesham Tawfik13 Department of Oncology, Faculty of Medicine, Tanta University, TantaEgyptView further author information
,
Hisham Ayoub14 Department of Gastroenterology, Military Medical Academy, Cairo, EgyptView further author information
,
Hussein Khaled11 Department of Oncology, Faculty of Medicine, Cairo University, Cairo, EgyptORCID Iconhttps://orcid.org/0000-0003-1118-7467View further author information
ORCID Icon,
Ibtessam Saadeldin11 Department of Oncology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Imam Waked15 Department of Gastroenterology, Menoufia Liver Institute, Menoufia, EgyptORCID Iconhttps://orcid.org/0000-0002-9857-8972View further author information
ORCID Icon,
Eman MF Barakat16 Department of Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, EgyptORCID Iconhttps://orcid.org/0000-0002-1869-6355View further author information
ORCID Icon,
Mahmoud El Meteini17 Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Mohamed Hamed Shaaban6 Department of Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Mohamed EzzElarab10 Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo, EgyptView further author information
,
Mohamed Fathy17 Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Mohamed Shaker5 Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Mohamed Sobhi5 Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Mohamed Kamal Shaker16 Department of Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Mohamed ElGharib5 Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Mohammed Abdullah11 Department of Oncology, Faculty of Medicine, Cairo University, Cairo, EgyptORCID Iconhttps://orcid.org/0000-0003-0199-074XView further author information
ORCID Icon,
Mohesn Mokhtar11 Department of Oncology, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Mostafa Elshazli18 Department of Surgery, Faculty of Medicine, Cairo University, Cairo, EgyptView further author information
,
Omar Mohamed Khaleil Heikal14 Department of Gastroenterology, Military Medical Academy, Cairo, EgyptView further author information
,
Osama Hetta5 Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Reda Mahmoud ElWakil16 Department of Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Sameh Abdel Wahab5 Department of Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, EgyptView further author information
,
Samir Shehata Eid19 Department of Oncology, Faculty of Medicine, Assiut University, Assiut, EgyptView further author information
&
Yousri Rostom20 Department of Oncology, Faculty of Medicine, Alexandria University, Alexandria, EgyptView further author information
 show all
Pages 1547-1571 | Received 26 Mar 2023, Accepted 01 Sep 2023, Published online: 18 Sep 2023

References

  • Waked I, Esmat G, Elsharkawy A, et al. Screening and treatment program to eliminate hepatitis C in Egypt. N Eng J Med. 2020;382(12):1166–1174. doi:10.1056/NEJMsr1912628
  • Laube R, Sabih A, Strasser SI, Lim L, Cigolini M, Liu K. Palliative care in hepatocellular carcinoma. J Gastroenterol Hepatol. 2021;36(3):618–628. doi:10.1111/jgh.15169
  • World Health Organization (WHO). Global Health Estimates 2020: estimated number of deaths in 2020, Egypt, both sexes, all ages (excl. NMSC). WHO; 2020. Available from: https://gco.iarc.fr/today/online-analysis-table?v=2020&mode=cancer&mode_population=countries&population=900&populations=818&key=asr&sex=0&cancer=39&type=1&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=0&include_nmsc_other=1. Accessed April 9, 2022.
  • Liu Z, Jiang Y, Yuan H, et al. The trends in incidence of primary liver cancer caused by specific etiologies: results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention. J Hepatol. 2019;70(4):674–683. doi:10.1016/j.jhep.2018.12.001
  • El-Zanaty F, Way A. Egypt Demographic and Health Survey, 2008 Cairo, Egypt: Ministry of Health and Population, 2009. Demographic and Health Survey (EDHS); 2009.
  • El-Zanaty and Associates. Egypt Health Issues Survey 2015. Rockville, MD: Ministry of Health and Population, ICF International; 2015.
  • Hassanin A, Kamel S, Waked I, Fort M. Egypt’s Ambitious Strategy to Eliminate Hepatitis C Virus: a Case Study. Glob Health Sci Pract. 2021;9(1):187–200. doi:10.9745/GHSP-D-20-00234
  • Lehman EM, Wilson ML. Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: a systematic review and meta-analysis. Int J Cancer. 2009;124(3):690–697. doi:10.1002/ijc.23937
  • Ministry of Health Egypt, El-Zanaty and Associates, ICF International. The 2015 Egypt Health Issues Survey (EHIS); 2015. Available from: https://dhsprogram.com/pubs/pdf/FR313/FR313.pdf. Accessed August 20, 2023.
  • Azzam A, Khaled H, Elbohy OA, et al. Seroprevalence of hepatitis B virus surface antigen (HBsAg) in Egypt (2000–2022): a systematic review with meta-analysis. BMC Infect Dis. 2023;23(1):151. doi:10.1186/s12879-023-08110-5
  • Hassany SM. Screening for hepatocellular carcinoma by Egyptian physicians. World J Gastrointest Oncol. 2015;7(9):161. doi:10.4251/wjgo.v7.i9.161
  • Singal AG, Pillai A, Tiro J. Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: a Meta-analysis. PLoS Med. 2014;11(4). doi:10.1371/journal.pmed.1001624
  • Guyatt GH, Oxman AD, Vist GE, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. doi:10.1136/bmj.39489.470347
  • Harris PS, Hansen RM, Gray ME, Massoud OI, McGuire BM, Shoreibah MG. Hepatocellular carcinoma surveillance: an evidence-based approach. World J Gastroenterol. 2019;25(13):1550–1559. doi:10.3748/wjg.v25.i13.1550
  • Song P, Cai Y, Tang H, Li C, Huang J. The clinical management of hepatocellular carcinoma worldwide: a concise review and comparison of current guidelines from 2001 to 2017. Biosci Trends. 2017;11(4):389–398. doi:10.5582/bst.2017.01202
  • McGivern DR, Lemon SM. Virus-specific mechanisms of carcinogenesis in hepatitis C virus associated liver cancer. Oncogene. 2011;30(17):1969–1983. doi:10.1038/onc.2010.594
  • Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358–380. doi:10.1002/hep.29086
  • Esmat G, El-Sayed MH, Hassany M, Doss W, Waked I. One step closer to elimination of hepatitis C in Egypt. Lancet Gastroenterol Hepatol. 2018;3(10):665. doi:10.1016/S2468-1253(18)30268-1
  • El Kassas M, Funk AL, Salaheldin M, et al. Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: a comparative analysis. J Viral Hepat. 2018;25(6):623–630. doi:10.1111/jvh.12854
  • Guarino M, Sessa A, Cossiga V, Morando F, Caporaso N, Morisco F. Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: a few lights and many shadows. World J Gastroenterol. 2018;24(24):2582–2595. doi:10.3748/wjg.v24.i24.2582
  • Adeniji N, Dhanasekaran R. Current and Emerging Tools for Hepatocellular Carcinoma Surveillance. Hepatol Commun. 2021;5(12):1972–1986. doi:10.1002/hep4.1823
  • Galle PR, Forner A, Llovet JM, et al. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236. doi:10.1016/j.jhep.2018.03.019
  • Yang JD, Kim WR, Coelho R, et al. Cirrhosis Is Present in Most Patients With Hepatitis B and Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2011;9(1):64–70. doi:10.1016/j.cgh.2010.08.019
  • Prenner SB, VanWagner LB, Flamm SL, Salem R, Lewandowski RJ, Kulik L. Hepatocellular carcinoma decreases the chance of successful hepatitis C virus therapy with direct-acting antivirals. J Hepatol. 2017;66(6):1173–1181. doi:10.1016/j.jhep.2017.01.020
  • El-Zayadi AR, Badran HM, Barakat EM, et al. Hepatocellular carcinoma in Egypt: a single center study over a decade. World J Gastroenterol. 2005;11(33):5193–5198.
  • El-Zayadi R. Prevalence and epidemiological features of hepatocellular carcinoma in Egypt—a single center experience. Hepatol Res. 2001;19(2):170–179. doi:10.1016/S1386-6346(00)00105-4
  • Makhlouf NA, Morsy KH, Mahmoud AA. Hepatitis D virus infection among hepatitis B virus surface antigen positive individuals in Upper Egypt: prevalence and clinical features. J Infect Public Health. 2018;12(3):350–356. doi:10.1016/j.jiph.2018.12.001
  • Elzefzafy W, Soliman R, Saleh L, et al. Seroprevalence and epidemiological characteristics of HDV infection among HBV patients in the Nile Delta, Egypt. J Viral Hepat. 2022;29(1):87–90. doi:10.1111/jvh.13621
  • Tang A, Hallouch O, Chernyak V, Kamaya A, Sirlin CB. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. Abdominal Radiol. 2018;43(1):13–25. doi:10.1007/s00261-017-1209-1
  • Ziada DH, El Sadany S, Soliman H, et al. Prevalence of hepatocellular carcinoma in chronic hepatitis C patients in Mid Delta, Egypt: a single center study. J Egypt Natl Canc Inst. 2016;28(4):257–262. doi:10.1016/j.jnci.2016.06.001
  • Velázquez R. Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology. 2003;37(3):520–527. doi:10.1053/jhep.2003.50093
  • Heimbach JK, Kulik LM, Finn RS, et al. AASLD Guidelines for the Treatment of Hepatocellular Carcinoma. OncoTargets Therap. 2017:5575. doi:10.1002/hep.29086/suppinfo
  • Gharib AF, Karam RA, Pasha HF, Radwan MI, Elsawy WH. Polymorphisms of hemochromatosis, and alpha-1 antitrypsin genes in Egyptian HCV patients with and without hepatocellular carcinoma. Gene. 2011;489(2):98–102. doi:10.1016/j.gene.2011.08.010
  • Motawi TK, Shaker OG, Ismail MF, Sayed NH. Genetic variants associated with the progression of hepatocellular carcinoma in hepatitis C Egyptian patients. Gene. 2013;527(2):516–520. doi:10.1016/j.gene.2013.06.053
  • Dawood R, Abd El Meguid M, Elrobe W, et al. Significance of Hereditary Hemochromatosis Gene (HFE) Mutations in Chronic Hepatitis C and Hepatocellular Carcinoma Patients in Egypt: a Pilot Study. Asian Pacific J Cancer Prevention. 2021;22(9):2837–2845. doi:10.31557/APJCP.2021.22.9.2837
  • Elmberg M, Hultcrantz R, Ekbom A, et al. Cancer risk in patients with hereditary hemochromatosis and in their first-degree relatives. Gastroenterology. 2003;125(6):1733–1741. doi:10.1053/j.gastro.2003.09.035
  • Liang Y, Yang Z, Zhong R. Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis. Hepatology. 2012;56(4):1409–1417. doi:10.1002/hep.25788
  • Hamed MA, Ali SA. Non-viral factors contributing to hepatocellular carcinoma. World J Hepatol. 2013;5(6):311. doi:10.4254/wjh.v5.i6.311
  • Tansel A, Katz LH, El-Serag HB, et al. Incidence and Determinants of Hepatocellular Carcinoma in Autoimmune Hepatitis: a Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(8):1207–1217.e4. doi:10.1016/j.cgh.2017.02.006
  • Meza-Junco J, Montaño-Loza AJ, Martínez-Benitez B, Kimura-Hayama E. Hepatocellular carcinoma in patients with autoimmune liver diseases: two case reports and literature review. Ann Hepatol. 2019;6(2):122–126.
  • Antoury C, Lopez R, Zein N, Stoller JK, Alkhouri N. Alpha-1 antitrypsin deficiency and the risk of hepatocellular carcinoma in end-stage liver disease. World J Hepatol. 2015;7(10):1427–1432. doi:10.4254/wjh.v7.i10.1427
  • Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–750. doi:10.1002/hep.29913
  • Omata M, Cheng AL, Kokudo N, et al. Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11(4):317–370. doi:10.1007/s12072-017-9799-9
  • Colli A, Fraquelli M, Casazza G, et al. Accuracy of Ultrasonography, Spiral CT, Magnetic Resonance, and Alpha-Fetoprotein in Diagnosing Hepatocellular Carcinoma: a Systematic Review. CME. Am J Gastroenterol. 2006;101(3):513–523. doi:10.1111/j.1572-0241.2006.00467.x
  • Kudo M, Kawamura Y, Hasegawa K, et al. Management of hepatocellular carcinoma in Japan: JSH consensus statements and recommendations 2021 update. Liver Cancer. 2021;10(3):181–223. doi:10.1159/000514174
  • Singal AG, Mittal S, Yerokun OA, et al. Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival Among Patients with Cirrhosis in the US. Am J Med. 2017;130(9):1099–1106.e1. doi:10.1016/j.amjmed.2017.01.021
  • Kim TH, Kim SY, Tang A, Lee JM. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma: 2018 update. Clin Mol Hepatol. 2019;25(3):245–263. doi:10.3350/cmh.2018.0090
  • Choi J, Kim G, Han S, Lee W, Chun S, Lim Y. Longitudinal Assessment of Three Serum Biomarkers to Detect Very Early‐Stage Hepatocellular Carcinoma. Hepatology. 2019;69(5):1983–1994. doi:10.1002/hep.30233
  • Caviglia GP, Abate ML, Petrini E, Gaia S, Rizzetto M. Highly sensitive alpha-fetoprotein, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein and des-gamma-carboxyprothrombin for hepatocellular carcinoma detection. Hepatol Res. 2016;46(3):E130–E135. doi:10.1111/hepr.12544
  • Kumada T, Toyoda H, Tada T, et al. High-sensitivity Lens culinaris agglutinin-reactive alpha-fetoprotein assay predicts early detection of hepatocellular carcinoma. J Gastroenterol. 2014;49(3):555–563. doi:10.1007/s00535-013-0883-1
  • Ibrahim HM, Elghannam MZ, Elkhawaga OAY, El-Sokkary AMA. Evaluation of serum alpha fetoprotein-L3 as an accuracy novel biomarker for the early diagnosis of hepatocellular carcinoma in Egyptian patients. Saudi J Biol Sci. 2021;28(10):5760–5764. doi:10.1016/j.sjbs.2021.06.020
  • Zakhary NI, Khodeer SM, Shafik HE, Abdel Malak CA. Impact of PIVKA-II in diagnosis of hepatocellular carcinoma. J Adv Res. 2013;4(6):539–546. doi:10.1016/j.jare.2012.10.004
  • Svobodova S, Karlikova M, Topolcan O, et al. PIVKA-II as a Potential New Biomarker for Hepatocellular Carcinoma – a Pilot Study. Vivo. 2018;32(6):1551–1554. doi:10.21873/invivo.11413
  • Morad WS, Basuni AA, Fouad T, et al. The value of PIVKA-II and AFP-L3% in the diagnosis of hepatocellular carcinoma with normal and abnormal AFP levels. Egyptian Liver J. 2013;3(1):1–5. doi:10.1097/01.ELX.0000424246.18235.c5
  • Johnson PJ, Pirrie SJ, Cox TF, et al. The Detection of Hepatocellular Carcinoma Using a Prospectively Developed and Validated Model Based on Serological Biomarkers. Cancer Epidemiol Bio Prevention. 2014;23(1):144–153. doi:10.1158/1055-9965.EPI-13-0870
  • Best J, Bilgi H, Heider D, et al. The GALAD scoring algorithm based on AFP, AFP-L3, and DCP significantly improves detection of BCLC early stage hepatocellular carcinoma. Z Gastroenterol. 2016;54(12):1296–1305. doi:10.1055/s-0042-119529
  • Schotten C, Ostertag B, Sowa JP, et al. Galad score detects early-stage hepatocellular carcinoma in a european cohort of chronic hepatitis b and c patients. Pharmaceuticals. 2021;14(8). doi:10.3390/ph14080735
  • Yang JD, Addissie BD, Mara KC, et al. GALAD Score for Hepatocellular Carcinoma Detection in Comparison with Liver Ultrasound and Proposal of GALADUS Score. Cancer Epidemiol Bio Prevention. 2019;28(3):531–538. doi:10.1158/1055-9965.EPI-18-0281
  • Lee YJ, Lee JM, Lee JS, et al. Hepatocellular Carcinoma: diagnostic Performance of Multidetector CT and MR Imaging—A Systematic Review and Meta-Analysis. Radiology. 2015;275(1):97–109. doi:10.1148/radiol.14140690
  • Roberts LR, Sirlin CB, Zaiem F, et al. Imaging for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Hepatology. 2018;67(1):401–421. doi:10.1002/hep.29487
  • Chernyak V, Fowler KJ, Kamaya A, et al. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology. 2018;289(3):816–830. doi:10.1148/radiol.2018181494
  • Lee YT, Wang JJ, Zhu Y, Agopian VG, Tseng HR, Yang JD. An Official Learning Resource of AASLD Review Diagnostic Criteria and Li-RaDs for Hepatocellular Carcinoma. J Hepatocell Carcinoma. 2021;17.
  • Liang Y, Xu F, Guo Y, et al. Diagnostic performance of LI-RADS for MRI and CT detection of HCC: a systematic review and diagnostic meta-analysis. Eur J Radiol. 2021;134:109404. doi:10.1016/j.ejrad.2020.109404
  • van der Pol CB, Lim CS, Sirlin CB, et al. Accuracy of the Liver Imaging Reporting and Data System in Computed Tomography and Magnetic Resonance Image Analysis of Hepatocellular Carcinoma or Overall Malignancy—A Systematic Review. Gastroenterology. 2019;156(4):976–986. doi:10.1053/j.gastro.2018.11.020
  • Lee S, Kim S, Roh YH, Choi J, Park M, Kim M. Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: a Systematic Review and Meta‐Analysis. Liver Int. 2020;40(6):1488–1497. doi:10.1111/liv.14424
  • Hanna RF, Miloushev VZ, Tang A, et al. Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma. Abdominal Radiol. 2016;41(1):71–90. doi:10.1007/s00261-015-0592-8
  • Becker-Weidman DJS, Kalb B, Sharma P, et al. Hepatocellular Carcinoma Lesion Characterization: single-Institution Clinical Performance Review of Multiphase Gadolinium-enhanced MR Imaging—Comparison to Prior Same-Center Results after MR Systems Improvements. Radiology. 2011;261(3):824–833. doi:10.1148/radiol.11110157
  • Attwa MH, El-Etreby SA. Guide for diagnosis and treatment of hepatocellular carcinoma. World J Hepatol. 2015;7(12):1632–1651. doi:10.4254/wjh.v7.i12.1632
  • Kinoshita A, Onoda H, Fushiya N, Koike K, Nishino H, Tajiri H. Staging systems for hepatocellular carcinoma: current status and future perspectives. World J Hepatol. 2015;7(3):406–424. doi:10.4254/wjh.v7.i3.406
  • Marrero JA, Fontana RJ, Barrat A, et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology. 2005;41(4):707–715. doi:10.1002/hep.20636
  • Gomaa AI, Hashim MS, Waked I. Comparing Staging Systems for Predicting Prognosis and Survival in Patients with Hepatocellular Carcinoma in Egypt. PLoS One. 2014;9(3):e90929. doi:10.1371/journal.pone.0090929
  • Cillo U, Bassanello M, Vitale A, et al. The critical issue of hepatocellular carcinoma prognostic classification: which is the best tool available? J Hepatol. 2004;40(1):124–131. doi:10.1016/j.jhep.2003.09.027
  • Cillo U, Vitale A, Grigoletto F, et al. Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol. 2006;44(4):723–731. doi:10.1016/j.jhep.2005.12.015
  • Guglielmi A, Ruzzenente A, Pachera S, et al. Comparison of Seven Staging Systems in Cirrhotic Patients With Hepatocellular Carcinoma in a Cohort of Patients Who Underwent Radiofrequency Ablation With Complete Response. Am J Gastroenterol. 2008;103(3):597–604. doi:10.1111/j.1572-0241.2007.01604.x
  • Vitale A, Saracino E, Boccagni P, et al. Validation of the BCLC Prognostic System in Surgical Hepatocellular Cancer Patients. Transplant Proc. 2009;41(4):1260–1263. doi:10.1016/j.transproceed.2009.03.054
  • Wang JH, Changchien CS, Hu TH, et al. The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma – survival analysis of 3892 patients. Eur J Cancer. 2008;44(7):1000–1006. doi:10.1016/j.ejca.2008.02.018
  • Abdelaziz AO, Elbaz TM, Shousha HI, et al. Survival and prognostic factors for hepatocellular carcinoma: an Egyptian multidisciplinary clinic experience. Asian Pacific J Cancer Prevention. 2014;15(9):3915–3920. doi:10.7314/APJCP.2014.15.9.3915
  • Bolondi L, Burroughs A, Dufour JF, et al. Heterogeneity of Patients with Intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a Subclassification to Facilitate Treatment Decisions. Semin Liver Dis. 2013;32(04):348–359. doi:10.1055/s-0032-1329906
  • Ha Y, Shim JH, Kim SO, Kim KM, Lim YS, Lee HC. Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis. J Gastroenterol Hepatol. 2014;29(4):787–793. doi:10.1111/jgh.12452
  • Wang JH, Kee KM, Lin CY, et al. Validation and modification of a proposed substaging system for patients with intermediate hepatocellular carcinoma. J Gastroenterol Hepatol. 2015;30(2):358–363. doi:10.1111/jgh.12686
  • Kudo M, Arizumi T, Ueshima K, Sakurai T, Kitano M, Nishida N. Subclassification of BCLC B Stage Hepatocellular Carcinoma and Treatment Strategies: proposal of Modified Bolondi’s Subclassification (Kinki Criteria). Digestive Dis. 2015;33(6):751–758. doi:10.1159/000439290
  • Kariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI Score for Predicting Hepatocellular Carcinoma Prognosis. Liver Cancer. 2020;9(6):734–743. doi:10.1159/000508971
  • Božin T, Mustapić S, Bokun T, et al. Albi score as a predictor of survival in patients with compensated cirrhosis resected for hepatocellular carcinoma: exploratory evaluation in relationship to palbi and meld liver function scores. Acta Clin Croat. 2018;57(2):292–300. doi:10.20471/acc.2018.57.02.09
  • Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of Liver Function in Patients With Hepatocellular Carcinoma: a New Evidence-Based Approach—The ALBI Grade. J Clin Oncol. 2015;33(6):550–558. doi:10.1200/JCO.2014.57.9151
  • Hiraoka A, Kumada T, Michitaka K, Kudo M. Newly Proposed ALBI Grade and ALBI-T Score as Tools for Assessment of Hepatic Function and Prognosis in Hepatocellular Carcinoma Patients. Liver Cancer. 2019;8(5):312–325. doi:10.1159/000494844
  • Faivre S, Raymond E, Boucher E, et al. Safety and efficacy of sunitinib in patients with advanced hepatocellular carcinoma: an open-label, multicentre, Phase II study. Lancet Oncol. 2009;10(8):794–800. doi:10.1016/S1470-2045(09)70171-8
  • Zhu AX, Sahani DV, Duda DG, et al. Efficacy, safety, and potential biomarkers of sunitinib monotherapy in advanced hepatocellular carcinoma: a phase II study. J Clin Oncol. 2009;27(18):3027–3035. doi:10.1200/JCO.2008.20.9908
  • Fang P. Efficacy and safety of bevacizumab for the treatment of advanced hepatocellular carcinoma: a systematic review of phase II trials. PLoS One. 2012;7(12):e49717–e49717. doi:10.1371/journal.pone.0049717
  • Ranpura V, Hapani S, Wu S. Treatment-Related Mortality With Bevacizumab in Cancer Patients: a Meta-analysis. JAMA. 2011;305(5):487–494. doi:10.1001/jama.2011.51
  • Girotra M, Soota K, Dhaliwal AS, Abraham RR, Garcia-Saenz-de-Sicilia M, Tharian B. Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: what does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging? World J Gastrointest Endosc. 2018;10(2):56–68. doi:10.4253/wjge.v10.i2.56
  • Bhutani M, Koduru P, Suzuki R, Lakhtakia S, Ramchandani M, Makmun D. Role of endoscopic ultrasound in diagnosis and management of hepatocellular carcinoma. J Hepatocell Carcinoma. 2015;143. doi:10.2147/JHC.S60868
  • Hsu C, Rimassa L, Sun HC, Vogel A, Kaseb AO. Immunotherapy in hepatocellular carcinoma: evaluation and management of adverse events associated with atezolizumab plus bevacizumab. Ther Adv Med Oncol. 2021;13:17588359211031140. doi:10.1177/17588359211031141
  • Gomaa AI. Recent advances in multidisciplinary management of hepatocellular carcinoma. World J Hepatol. 2015;7(4):673. doi:10.4254/wjh.v7.i4.673
  • Sinn DH, Choi GS, Park HC, et al. Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients. PLoS One. 2019;14(1). doi:10.1371/journal.pone.0210730
  • Zaky S. Multidisciplinary decision making in the management of hepatocellular carcinoma: a hospital-based study. Turkish J Gastroenterol. 2015;26(6):498–505. doi:10.5152/tjg.2015.0158
  • Barone C, Koeberle D, Metselaar H, Parisi G, Sansonno D, Spinzi G. Multidisciplinary approach for HCC patients: hepatology for the oncologists. Ann Oncol. 2013;24:15–23. doi:10.1093/annonc/mdt053
  • Dodd GD, Miller WJ, Baron RL, Skolnick ML, Campbell WL. Detection of malignant tumors in end-stage cirrhotic livers: efficacy of sonography as a screening technique. Am J Roentgenol. 1992;159(4):727–733. doi:10.2214/ajr.159.4.1326883
  • Senbel A, Elmahdy Y, Roshdy S, et al. Role of Hepatic Resection for HCC in the era of Transplantation; an Experience of Two Tertiary Egyptian Centers. Indian J Surg Oncol. 2017;8(4):514–518. doi:10.1007/s13193-017-0679-5
  • Bruix J, Castells A, Bosch J, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111(4):1018–1022. doi:10.1016/S0016-5085(96)70070-7
  • Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–1022. doi:10.1002/hep.24199
  • Allaire M, Goumard C, Lim C, le Cleach A, Wagner M, Scatton O. New Frontiers in Liver Resection for Hepatocellular Carcinoma. JHEP Reports. 2020:100134.
  • Mai RY, Wang YY, Bai T, et al. Combination of ALBI and APRI to predict posthepatectomy liver failure after liver resection for HBV-related HCC patients. Cancer Manag Res. 2019;11:8799–8806. doi:10.2147/CMAR.S213432
  • Izzo F, Granata V, Grassi R, et al. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: an Update. Oncologist. 2019;24(10):e990–e1005. doi:10.1634/theoncologist.2018-0337
  • Khan A, Mostowy M, Owusu M, et al. Microwave ablation determines similar survival outcomes as compared to radiofrequency ablation for the treatment of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol. 2021;15(7):829–833. doi:10.1080/17474124.2021.1869939
  • Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M. Radiofrequency Thermal Ablation vs. Percutaneous Ethanol Injection for Small Hepatocellular Carcinoma in Cirrhosis: meta-Analysis of Randomized Controlled Trials. Am J Gastroenterol. 2009;104(2):514–524. doi:10.1038/ajg.2008.80
  • Cho YK, Kim JK, Kim MY, Rhim H, Han JK. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology. 2009;49(2):453–459. doi:10.1002/hep.22648
  • Shen A, Zhang H, Tang C, et al. A systematic review of radiofrequency ablation versus percutaneous ethanol injection for small hepatocellular carcinoma up to 3 cm. J Gastroenterol Hepatol. 2013;28(5):793–800. doi:10.1111/jgh.12162
  • Livraghi T, Meloni F, Di Stasi M, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47(1):82–89. doi:10.1002/hep.21933
  • Zanus G, Boetto R, Gringeri E, et al. Microwave Thermal Ablation for Hepatocarcinoma: six Liver Transplantation Cases. Transplant Proc. 2011;43(4):1091–1094. doi:10.1016/j.transproceed.2011.02.044
  • Facciorusso A, Abd El Aziz MA, Tartaglia N, et al. Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: a Meta-Analysis of Randomized Controlled Trials. Cancers. 2020;12(12):3796. doi:10.3390/cancers12123796
  • Lencioni R, Crocetti L, De Simone P, Filipponi F. Loco-regional interventional treatment of hepatocellular carcinoma: techniques, outcomes, and future prospects. Transplant Int. 2010;23(7):698–703. doi:10.1111/j.1432-2277.2010.01109.x
  • Kamal A, Elmoety AAA, Rostom YAM, Shater MS, Lashen SA. Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial. J Gastrointest Oncol. 2019;10(3):562–571. doi:10.21037/jgo.2019.01.34
  • Müller L, Stoehr F, Mähringer-Kunz A, Hahn F, Weinmann A, Kloeckner R. Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide. J Hepatocell Carcinoma. 2021;8:403–419. doi:10.2147/jhc.s285735
  • Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35(5):1164–1171. doi:10.1053/jhep.2002.33156
  • Llovet J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37(2):429–442. doi:10.1053/jhep.2003.50047
  • Cammà C, Schepis F, Orlando A, et al. Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: meta-Analysis of Randomized Controlled Trials. Radiology. 2002;224(1):47–54. doi:10.1148/radiol.2241011262
  • Elshaarawy O, Gomaa A, Omar H, Rewisha E, Waked I. Intermediate stage hepatocellular carcinoma: a summary review. J Hepatocell Carcinoma. 2019;6:105–117. doi:10.2147/JHC.S168682
  • Bessar AA, Farag A, Abdel Monem SM, et al. Transarterial chemoembolisation in patients with hepatocellular carcinoma: low-dose doxorubicin reduces post-embolisation syndrome without affecting survival—prospective interventional study. Eur Radiol Exp. 2021;5(1):10. doi:10.1186/s41747-021-00204-6
  • Zeeneldin AA, Salem SE, Tabashy RH, Ibrahim AA, Alieldin NH. Transarterial chemoembolization for the treatment of hepatocellular carcinoma: a single center experience including 221 patients. J Egypt Natl Canc Inst. 2013;25(3):143–150. doi:10.1016/j.jnci.2013.05.003
  • Abdelaziz AO, Abdelmaksoud AH, Nabeel MM, et al. Transarterial Chemoembolization Combined with Either Radiofrequency or Microwave Ablation in Management of Hepatocellular Carcinoma. Asian Pac J Cancer Prev. 2017;18(1):189–194. doi:10.22034/APJCP.2017.18.1.189
  • Hucke F, Pinter M, Graziadei I, et al. How to STATE suitability and START transarterial chemoembolization in patients with intermediate stage hepatocellular carcinoma. J Hepatol. 2014;61(6):1287–1296. doi:10.1016/j.jhep.2014.07.002
  • Kadalayil L, Benini R, Pallan L, et al. A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol. 2013;24(10):2565–2570. doi:10.1093/annonc/mdt247
  • Kloeckner R, Pitton MB, Dueber C, et al. Validation of Clinical Scoring Systems ART and ABCR after Transarterial Chemoembolization of Hepatocellular Carcinoma. J Vascular Int Radiol. 2017;28(1):94–102. doi:10.1016/j.jvir.2016.06.012
  • Pinato DJ, Arizumi T, Jang JW, et al. Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study. Oncotarget. 2016;7(28):44705–44718. doi:10.18632/oncotarget.9604
  • Sieghart W, Hucke F, Pinter M, et al. The ART of decision making: retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma. Hepatology. 2013;57(6):2261–2273. doi:10.1002/hep.26256
  • Hucke F, Sieghart W, Pinter M, et al. The ART-strategy: sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE. J Hepatol. 2014;60(1):118–126. doi:10.1016/j.jhep.2013.08.022
  • Sacco R, Conte C, Tumino E, et al. Transarterial radioembolization for hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016;3:25–29. doi:10.2147/jhc.s50359
  • Jelic S, Sotiropoulos GC. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21:v59–v64. doi:10.1093/annonc/mdq166
  • Thomas MB, Jaffe D, Choti MM, et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol. 2010;28(25):3994–4005. doi:10.1200/JCO.2010.28.7805
  • Iñarrairaegui M, Pardo F, Bilbao JI, et al. Response to radioembolization with yttrium-90 resin microspheres may allow surgical treatment with curative intent and prolonged survival in previously unresectable hepatocellular carcinoma. Eur J Surgical Oncol. 2012;38(7):594–601. doi:10.1016/j.ejso.2012.02.189
  • de la Torre MA, Buades-Mateu J, de la Rosa PA, et al. A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib. Liver Int. 2016;36(8):1206–1212. doi:10.1111/liv.13098
  • Mazzaferro V, Sposito C, Bhoori S, et al. Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study. Hepatology. 2013;57(5):1826–1837. doi:10.1002/hep.26014
  • Garin E, Lenoir L, Edeline J, et al. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept. Eur J Nucl Med Mol Imaging. 2013;40(7):1057–1068. doi:10.1007/s00259-013-2395-x
  • El Fouly A, Ertle J, El Dorry A, et al. In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization? Liver Int. 2015;35(2):627–635. doi:10.1111/liv.12637
  • Mazzaferro V, Chun YS, Poon RTP, et al. Liver Transplantation for Hepatocellular Carcinoma. Ann Surg Oncol. 2008;15(4):1001–1007. doi:10.1245/s10434-007-9559-5
  • Lankarani KB, Hosseini SAM. The Status of Liver Transplantation in the Middle East. Clin Liver Dis. 2019;14(6):215–218. doi:10.1002/cld.889
  • Yao F. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394–1403. doi:10.1053/jhep.2001.24563
  • Yao FY, Xiao L, Bass NM, Kerlan R, Ascher NL, Roberts JP. Liver Transplantation for Hepatocellular Carcinoma: validation of the UCSF-Expanded Criteria Based on Preoperative Imaging. Am J Transplantation. 2007;7(11):2587–2596. doi:10.1111/j.1600-6143.2007.01965.x
  • Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10(1):35–43. doi:10.1016/S1470-2045(08)70284-5
  • Azzam AZ. Liver transplantation as a management of hepatocellular carcinoma. World J Hepatol. 2015;7(10):1347. doi:10.4254/wjh.v7.i10.1347
  • Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13(1):e11–e22. doi:10.1016/S1470-2045(11)70175-9
  • Yao FY, Mehta N, Flemming J, et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61(6):1968–1977. doi:10.1002/hep.27752
  • Lei J, Wang W, Yan L. Downstaging Advanced Hepatocellular Carcinoma to the Milan Criteria May Provide a Comparable Outcome to Conventional Milan Criteria. J Gastrointestinal Surgery. 2013;17(8):1440–1446. doi:10.1007/s11605-013-2229-y
  • Bova V, Miraglia R, Maruzzelli L, Vizzini GB, Luca A. Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies. Cardiovasc Intervent Radiol. 2013;36(2):433–439. doi:10.1007/s00270-012-0458-1
  • Berry K, Ioannou GN. Serum alpha-fetoprotein level independently predicts posttransplant survival in patients with hepatocellular carcinoma. Liver Transplantation. 2013;19(6):634–645. doi:10.1002/lt.23652
  • Raoul JL, Gilabert M, Piana G. How to Define Transarterial Chemoembolization Failure or Refractoriness: a European Perspective. Liver Cancer. 2014;3(2):119–124. doi:10.1159/000343867
  • Raoul JL, Sangro B, Forner A, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2011;37(3):212–220. doi:10.1016/j.ctrv.2010.07.006
  • Piscaglia F, Bolondi L. The intermediate hepatocellular carcinoma stage: should treatment be expanded? Digestive Liver Dis. 2010;42:S258–S263. doi:10.1016/S1590-8658(10)60514-2
  • Ogasawara S, Chiba T, Ooka Y, et al. Efficacy of sorafenib in intermediate-stage hepatocellular carcinoma patients refractory to transarterial chemoembolization. Oncology. 2014;87(6):330–341. doi:10.1159/000365993
  • Arizumi T, Ueshima K, Chishina H, et al. Validation of the Criteria of Transcatheter Arterial Chemoembolization Failure or Refractoriness in Patients with Advanced Hepatocellular Carcinoma Proposed by the LCSGJ. Oncology. 2014;87(s1):32–36. doi:10.1159/000368143
  • Arizumi T, Ueshima K, Minami T, et al. Effectiveness of Sorafenib in Patients with Transcatheter Arterial Chemoembolization (TACE) Refractory and Intermediate-Stage Hepatocellular Carcinoma. Liver Cancer. 2015;4(4):253–262. doi:10.1159/000367743
  • Hack SP, Spahn J, Chen M, et al. IMbrave 050: a Phase III trial of atezolizumab plus bevacizumab in high-risk hepatocellular carcinoma after curative resection or ablation. Future Oncol. 2020;16(15):975–989. doi:10.2217/fon-2020-0162
  • Vogel A, Martinelli E, Cervantes A, et al. Updated treatment recommendations for hepatocellular carcinoma (HCC) from the ESMO Clinical Practice Guidelines. Ann Oncol. 2021;32(6):801–805. doi:10.1016/j.annonc.2021.02.014
  • Abdel-Rahman O. Systemic therapy for hepatocellular carcinoma (HCC): from bench to bedside. J Egypt Natl Canc Inst. 2013;25(4):165–171. doi:10.1016/j.jnci.2013.08.002
  • Akateh C, Black SM, Conteh L, et al. Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma. World J Gastroenterol. 2019;25(28):3704–3721. doi:10.3748/wjg.v25.i28.3704
  • Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10(1):25–34. doi:10.1016/S1470-2045(08)70285-7
  • Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in Advanced Hepatocellular Carcinoma. N Eng J Med. 2008;359(4):378–390. doi:10.1056/NEJMoa0708857
  • Abdel-Rahman O, Cheung WY. The expanding role of systemic therapy in the management of hepatocellular carcinoma. Can J Gastroenterol Hepatol. 2018;2018:1–4. doi:10.1155/2018/4763832
  • Yamashita T, Kudo M, Ikeda K, et al. REFLECT-a phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: an analysis of Japanese subset. J Gastroenterol. 2020;55(1):113–122. doi:10.1007/s00535-019-01642-1
  • Kokudo N, Takemura N, Hasegawa K, et al. Clinical practice guidelines for hepatocellular carcinoma: the Japan Society of Hepatology 2017 (4th JSH‐HCC guidelines) 2019 update. Hepatol Res. 2019;49(10):1109–1113. doi:10.1111/hepr.13411
  • Bruix J, Qin S, Merle P, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389(10064):56–66. doi:10.1016/S0140-6736(16)32453-9
  • Zhu AX, Kang YK, Yen CJ, et al. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased α-fetoprotein concentrations (REACH-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20(2):282–296. doi:10.1016/S1470-2045(18)30937-9
  • Abou-Alfa GK, Meyer T, Cheng AL, et al. Cabozantinib in Patients with Advanced and Progressing Hepatocellular Carcinoma. N Eng J Med. 2018;379(1):54–63. doi:10.1056/NEJMoa1717002
  • Kelley RK, Sangro B, Harris W, et al. Safety, Efficacy, and Pharmacodynamics of Tremelimumab Plus Durvalumab for Patients With Unresectable Hepatocellular Carcinoma: randomized Expansion of a Phase I/II Study. J Clin Oncol. 2021;39(27):2991–3001. doi:10.1200/JCO.20.03555
  • K AAG, George L, Masatoshi K, et al. Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma. NEJM Evidence. 2022;1(8):EVIDoa2100070. doi:10.1056/EVIDoa2100070
  • Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76(3):681–693. doi:10.1016/j.jhep.2021.11.018
  • Bruix J, Chan SL, Galle PR, Rimassa L, Sangro B. Systemic treatment of hepatocellular carcinoma: an EASL position paper. J Hepatol. 2021;75(4):960–974. doi:10.1016/j.jhep.2021.07.004
  • Bruix J. Endpoints in clinical trials for liver cancer and their value in evidence-based clinical decision making: an unresolved Gordian knot. J Hepatol. 2021;74(6):1483–1488. doi:10.1016/j.jhep.2021.01.033
  • Bruix J, Takayama T, Mazzaferro V, et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015;16(13):1344–1354. doi:10.1016/S1470-2045(15)00198-9
  • Liu Y, Wang Y, Guo X, et al. Comparative Effectiveness of adjuvant treatment for resected hepatocellular carcinoma: a systematic review and network meta-analysis. Front Oncol. 2021:11. doi:10.3389/fonc.2021.709278
  • Bruix J, Sherman M, Llovet JM, et al. Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL Conference. J Hepatol. 2001;35(3):421–430. doi:10.1016/S0168-8278(01)00130-1
  • Lencioni R. New Data Supporting Modified RECIST (mRECIST) for Hepatocellular Carcinoma. Clin Cancer Res. 2013;19(6):1312–1314. doi:10.1158/1078-0432.CCR-12-3796
  • Vincenzi B, Di Maio M, Silletta M, et al. Prognostic Relevance of Objective Response According to EASL Criteria and mRECIST Criteria in Hepatocellular Carcinoma Patients Treated with Loco-Regional Therapies: a Literature-Based Meta-Analysis. PLoS One. 2015;10(7):e0133488. doi:10.1371/journal.pone.0133488
  • Lencioni R, Montal R, Torres F, et al. Objective response by mRECIST as a predictor and potential surrogate end-point of overall survival in advanced HCC. J Hepatol. 2017;66(6):1166–1172. doi:10.1016/j.jhep.2017.01.012
  • Meyer T, Palmer DH, Cheng AL, Hocke J, Loembé AB, Yen CJ. mRECIST to predict survival in advanced hepatocellular carcinoma: analysis of two randomised phase II trials comparing nintedanib vs sorafenib. Liver Int. 2017;37(7):1047–1055. doi:10.1111/liv.13359
  • Abdella H, Shaker MK, Montasser IF, et al. Outcome of transarterial chemoembolization in Egyptian patients with hepatocellular carcinoma and branch portal vein thrombosis. Indian J Gastroenterol. 2018;37(2):127–132. doi:10.1007/s12664-018-0830-4
  • Nabavizadeh N, Mitin T, Dawson LA, Hong TS, Thomas CR. Stereotactic body radiotherapy for patients with hepatocellular carcinoma and intermediate grade cirrhosis. Lancet Oncol. 2017;18(4):e192. doi:10.1016/S1470-2045(17)30162-6
  • Huo YR, Eslick GD. Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma. JAMA Oncol. 2015;1(6):756. doi:10.1001/jamaoncol.2015.2189
  • Lencioni R, Llovet JM, Han G, et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: the SPACE trial. J Hepatol. 2016;64(5):1090–1098. doi:10.1016/j.jhep.2016.01.012
  • Meyer T, Fox R, Ma YT, et al. Sorafenib in combination with transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma (TACE 2): a randomised placebo-controlled, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol. 2017;2(8):565–575. doi:10.1016/S2468-1253(17)30156-5
  • Chao Y, Chung YH, Han G, et al. The combination of transcatheter arterial chemoembolization and sorafenib is well tolerated and effective in Asian patients with hepatocellular carcinoma: final results of the START trial. Int J Cancer. 2015;136(6):1458–1467. doi:10.1002/ijc.29126
  • Zou X, Fan W, Xue M, Li J. Evaluation of the Benefits of TACE Combined with Sorafenib for Hepatocellular Carcinoma Based on Untreatable TACE (unTACEable) Progression. Cancer Manag Res. 2021;13:4013–4029. doi:10.2147/CMAR.S304591
  • Han Y, Cao G, Sun B, et al. Regorafenib combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: a real-world study. BMC Gastroenterol. 2021;21(1):393. doi:10.1186/s12876-021-01967-3
  • Kumar M, Panda D. Role of supportive care for terminal stage hepatocellular carcinoma. J Clin Exp Hepatol. 2014;4:S130–S139. doi:10.1016/j.jceh.2014.03.049
  • Schütte K, Balbisi F, Malfertheiner P. Prevention of Hepatocellular Carcinoma. Gastrointest Tumors. 2016;3(1):37–43. doi:10.1159/000446680
  • Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clin Gastroenterol Hepatol. 2015;13(12):2140–2151. doi:10.1016/j.cgh.2015.08.014
  • World Health Organization. Hepatitis B. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Accessed September 2, 2023.
  • Lange NF, Radu P, Dufour JF. Prevention of NAFLD-associated HCC: role of lifestyle and chemoprevention. J Hepatol. 2021;75(5):1217–1227. doi:10.1016/j.jhep.2021.07.025
  • Simon TG, Ma Y, Ludvigsson JF, et al. Association between aspirin use and risk of hepatocellular carcinoma. JAMA Oncol. 2018;4(12):1683. doi:10.1001/jamaoncol.2018.4154
  • Hayat U, Siddiqui AA, Okut H, Afroz S, Tasleem S, Haris A. The effect of coffee consumption on the non-alcoholic fatty liver disease and liver fibrosis: a meta-analysis of 11 epidemiological studies. Ann Hepatol. 2021;20:100254. doi:10.1016/j.aohep.2020.08.071
  • Cheng AL, Amarapurkar D, Chao Y, et al. Re-evaluating transarterial chemoembolization for the treatment of Hepatocellular Carcinoma: consensus recommendations and review by an International Expert Panel. Liver Int. 2014;34(2):174–183. doi:10.1111/liv.12314

Related research

People also read lists articles that other readers of this article have read.

Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine.

Cited by lists all citing articles based on Crossref citations.
Articles with the Crossref icon will open in a new tab.