Table 1.
Comparing risk assessment and management in guidelines.
| AASLD | EASL | JSHd | APASLd | KLCSGf | NCCN | ||
|---|---|---|---|---|---|---|---|
| Risk assessment | PS | Y1 | Y2 | N | N | N | N |
| Liver function | Y | Y | Y | Y | N | N | |
| Pathological facto | rs Y | Y | Y | Y | Y | Y | |
| AB | Early-stage | Advanced stage | Low-risk3 | Low-risk3 | Stage II | Stage IIIA | |
| XY | Advanced stage | Advanced stage | Intermediate risk3 | Intermediate risk3 | Stage III | Stage IIIB | |
| Management of HCC | OLT | Earlya Terminala Intermediateab |
Early | Terminal | Terminal stage (without mets) | Stage II/III (Milan’s criteria) | UNOS criteria |
| Ablation | Very earlya Earlya | Very early | Early | Early | Stage I Stage II (without VI) | Unresectable/ Non-operable/ Transplant-ineligible | |
| Surgery | Very early Earlya |
Very early | Early Advanced | No specific stage | Stage I Stage II (single lesion without VI) | Resectable | |
| TACE | Earlya Intermediate |
Intermediate | Early Intermediate Advanced |
Intermediate Advanced (alternative) |
Stage II Unresectable/ (except single Non-operable/ lesion without V) Transplant- Stage III ineligible | ||
| TARE | Earlya Intermediatea Advancedac |
NR | NR | NR | NR | Unresectable/ Non-operable/ Transplant-ineligible | |
| SBRT | Earlya | NR | NR | NR | Stage II/III (VI+) | NR | |
| EBRT | NR | NR | NR | NR | Stage II/III/IV (VI+) | Unresectable/ Non-operable/ Transplant-ineligible | |
| HAIC | NR | NR | Intermediate Advanced | NR | Any Stage III | NR | |
| TKI | Advanced | Advanced | Intermediate Advanced | Intermediatee Advanced |
Stage II/III (VI+) Stage IV | Unresectable/ Non-operable/ Metastatic | |
| ICI | Advanceda | NR | NR | NR | NR | Unresectable/ Non-operable/ Metastatic | |
| BSC | Terminal | Terminal | CP C not transplantable | CP C with mets | NR | CP C with mets | |
| AB | Ablation TACE TARE SBRT | Best supportive care | TACE | TACE TKI for residual disease |
TACE ABLATION | Ablation/TACE /TARE EBRT/BSC/TKI/ICI |
|
| XY | TKI ICI and TARE are alternatives |
TKI | TACE TKI HAIC |
TKI TACE | TACE TACE + SBRT TKI |
Ablation/TACE /TARE EBRT/BSC/TKI/ICI |
AASLD, American Association for the Study of Liver Disease; EASL, European Association for the Study of the Liver; JSH, Japanese Society for Hepatology; APASL, Asian Pacific Association for the Study of the Liver; KLCSG, Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines; NCCN, National Comprehensive Cancer Network; PS, performance status; HCC, hepatocellular carcinoma; OLT, orthotopic liver transplantation; TACE, transarterial chemoembolization; TARE, transarterial radioembolization; SBRT, stereotactic radiation therapy; EBRT, external radiation therapy; HAIC, hepatic artery infusion chemotherapy; TKI, tyrosine kinase inhibitors; ICI, immune-checkpoint inhibitors; BSC, best supportive care; NR, not recommended; VI, vascular invasion. a= Level 2 evidence; b= to downstage c= level 3 evidence; d= comparable groups with AASLD or EASL; e= if TACE is ineffective; f= only CP A with no portal hypertension and ECOG 0-1. 1= Early and intermediate stage can have ECOG of 1; 2= ECOG of 1, places a patient in an advanced stage; 3= comparable to AASLD/EASL stratification.