J Liver Cancer.  2025 Mar;25(1):19-30. 10.17998/jlc.2025.02.03.

A concise review of updated global guidelines for the management of hepatocellular carcinoma: 2017-2024

• Shin H
• Yu SJ

• KMID: 2567061
• DOI: http://doi.org/10.17998/jlc.2025.02.03

Abstract

Many guidelines for hepatocellular carcinoma (HCC) have been published and are regularly updated worldwide. HCC management involves a broad range of treatment options and requires multidisciplinary care, resulting in significant heterogeneity in management practices across international communities. To support standardized care for HCC, we systematically appraised 13 globally recognized guidelines and expert consensus statements, including five from Asia, four from Europe, and four from the United States. These guidelines share similarities but reveal notable discrepancies in surveillance strategies, treatment allocation, and other recommendations. Geographic differences in tumor biology (e.g., prevalence of viral hepatitis, alcohol-related liver disease, or metabolic dysfunction-associated steatotic liver disease) and disparities in available medical resources (e.g., organ availability, healthcare infrastructure, and treatment accessibility) complicate the creation of universally applicable guidelines. Previously, significant gaps existed between Asian and Western guidelines, particularly regarding treatment strategies. However, these differences have diminished over the years. Presently, variations are often more attributable to publication dates than to regional differences. Nonetheless, Asia-Pacific experts continue to diverge from the Barcelona Clinic Liver Cancer system, particularly with respect to surgical resection and locoregional therapies, which are viewed as overly conservative in Western guidelines. Advancements in systemic therapies have prompted ongoing updates to these guidelines. Given that each set of guidelines reflects distinct regional characteristics, strengths, and limitations, fostering collaboration and mutual complementarity is essential for addressing discrepancies and advancing global HCC care.

Keyword

Carcinoma, hepatocellular; Transplantation; Therapeutic chemoembolization; Chemotherapy; BCLC

Figure

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  Figure 1. Comparison of first-line treatment allocation between the Korean Liver Cancer Association-National Cancer Center of Korea (KLCA-NCC) and Barcelona Clinic Liver Cancer (BCLC) guidelines. (A) Shared pathways and (B) KLCA-NCC and BCLC pathways shown separately. VI, vascular invasion; Vp1, tumor thrombus in the segmental branches of the PV; Vp2, tumor thrombus in the second-order branches of the PV; Vp3, tumor thrombus in the first-order branches of the PV; Vp4, tumor thrombus in the main trunk of the PV and/or branches of the PV contralateral to the primarily involved lobe; TACE, transarterial chemoembolization; RT, radiotherapy; TARE, transarterial radioembolization; PV, portal vein. *KLCA-NCC recommends surgical resection as an alternative option. †KLCA-NCC recommends combination treatment of conventional TACE plus EBRT for certain cases of hepatocellular carcinoma (HCC) with vascular invasion. ‡KLCA-NCC recommends transarterial radioembolization for single HCC with Vp1-2 or without VI, as well as for multiple localized HCC without VI, as an alternative option.

Reference

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