Table 1.
Summary of Asian guidelines for the treatment of advanced (BCLC stage C) HCC with macrovascular invasion or extrahepatic metastases (or both) (adapted and updated from Chen et al. 2020 [12]).
| Country or Region of Origin of the Guideline | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Asia Pacific (APASL) [11] |
China [14] |
Hong Kong (HKLCS) [17] |
Japan (JSH) [13] |
Korea (KLCSG) [5] |
Singapore (NCCS) [15] |
Taiwan (TLCA) [16] |
||||||||
|
Disease
features |
MVI+ | EHM+ | MVI+ (IIIa) | EHM+ (IIIb) | Int. I or IIa + Vp 1–3 LA IIb or IIIa + Vp 1–3 |
EVM (IVa, IVb) Vp 4 or EHM (or both) |
MVI+ | EHM+ | MVI+
(IIc, IIIb, IVa) Single Multiple |
EHM+
IVa (LN), IVb (others) |
MVI+ | EHM+ | MVI+ | EHM+ |
|
First-line
treatment |
Systemic therapy, TACE | CP A or B: systemic therapy CP C: best supportive care |
TACE ± (MKI or FOLFOX4, LR, RT) |
MKI or FOLFOX4 ± (TACE, RT) |
IIb or IIIa, CP A: LR |
Systemic therapy | TACE, LR, HAIC, MKI | MKI | TACE (SIRT) ± EBRT Sorafenib Lenvatinib |
Sorafenib Lenvatinib |
SIRT, TACE | Systemic therapy | LR, MKI | Systemic therapy ± (TACE, SIRT, LR) |
|
Second-line
treatment |
MKI | MKI | IIb or IIIa, CP B, or IIIb: TACE |
(Vp 1–3: LR x 1–3) |
(TACE, EBRT) | Systemic therapy | TACE + RT | Chemo-therapy | ||||||
|
Later line of
treatment |
(CT, HAIC if MKI failed or not available) |
SIRT, HAIC | ||||||||||||
APASL, Asian Pacific Association for the Study of the Liver; CP, Child–Pugh; CT, computed tomography; EBRT, external beam radiation therapy; EHM, extrahepatic metastasis; EVM, extrahepatic vascular metastasis; FOLFOX4, folinic acid (leucovorin), 5-fluorouracil, and oxaliplatin; HAIC, hepatic arterial infusion chemotherapy; HKLCS, Hong Kong Liver Cancer Staging system; Int., intermediate; JSH, Japan Society of Hepatology; KLCSG, Korean Liver Cancer Study Group; LA, locally advanced; LN, lymph node; LR, liver resection; MKI, multikinase inhibitor; MVI, macrovascular invasion; RT, radiation therapy; SIRT, selective internal radiotherapy; TACE, transarterial chemoembolisation; TLCA, Taiwan Liver Cancer Association; Vp 1–3, portal vein thrombosis with involvement of unilateral 3rd (Vp1), 2nd (Vp2) or 1st branch (Vp3) of portal vein or bilateral 1st branches.