Study on guidelines of Chinese Society of Clinical Oncology (CSCO): hepatocellular carcinoma (2022)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaohao ^1,2,3 , LI Hu ^1,2,3 , ZHANG Lu ^1,2,3 ,  CAI Dachuan ^1,2,3

1. Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 401336, P. R. China;
2. Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing 401336, P. R. China;
3. Institute for Viral Hepatitis, Chongqing Medical University, Chongqing 401336, P. R. China;

Corresponding?author：

CAI Dachuan, Email: cqmucdc@cqmu.edu.cn

Keywords：

hepatocellular carcinoma; guideline; treatment; study

DOI：

10.7507/1007-9424.202301029

Video：

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To further standardize the clinical diagnosis and treatment behavior of hepatocellular carcinoma, based on evidence-based medical evidence and expert opinion, Chinese Society of Clinical Oncology updated and published guideline of hepatocellular carcinoma. In this paper, the new guideline on the updating of medical treatment strategies for hepatocellular carcinoma was studied.

Citation： WANG Xiaohao, LI Hu, ZHANG Lu, CAI Dachuan. Study on guidelines of Chinese Society of Clinical Oncology (CSCO): hepatocellular carcinoma (2022). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(4): 403-407. doi: 10.7507/1007-9424.202301029 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016. J Natl Cancer Cent, 2022, 2: 1-9.
3.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
4.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
5.	Fan R, Papatheodoridis G, Sun J, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. J Hepatol, 2020, 73(6): 1368-1378.
6.	Allemani C, Weir HK, Carreira H, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet, 2015, 385(9972): 977-1010.
7.	國家衛生健康委辦公廳. 原發性肝癌診療指南 (2022 年版). 臨床肝膽病雜志, 2022, 38(2): 288-303.
8.	中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療規范 (2019年版). 臨床肝膽病雜志, 2020, 36(2): 277-292.
9.	Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med, 2020, 382(20): 1894-1905.
10.	Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 2008, 359(4): 378-390.
11.	Qin S, Bai Y, Lim HY, et al. Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia. J Clin Oncol, 2013, 31(28): 3501-3508.
12.	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.
13.	Qin S, Bi F, Gu S, et al. Donafenib versus sorafenib in first-line treatment of unresectable or metastatic hepatocellular carcinoma: a randomized, open-label, parallel-controlled phase Ⅱ–Ⅲ trial. J Clin Oncol, 2021, 39(27): 3002-3011.
14.	Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet, 2018, 391(10126): 1163-1173.
15.	Ren Z, Xu J, Bai Y, et al. Sintilimab plus a bevacizumab biosimilar (IBI305) versus sorafenib in unresectable hepatocellular carcinoma (ORIENT-32): a randomised, open-label, phase 2-3 study. Lancet Oncol, 2021, 22(7): 977-990.
16.	Qin S, Ren Z, Meng Z, et al. Camrelizumab in patients with previously treated advanced hepatocellular carcinoma: a multicentre, open-label, parallel-group, randomised, phase 2 trial. Lancet Oncol, 2020, 21(4): 571-580.
17.	Ren Z, Qin S, Meng Z, et al. A phase 2 study of camrelizumab for advanced hepatocellular carcinoma: two-year outcomes and continued treatment beyond first RECIST-defined progression. Liver Cancer, 2021, 10(5): 500-509.
18.	Abou-Alfa GK, Chan SL, Kudo M, et al. A randomized, multicenter phase 3 study of durvalumab (D) and tremelimumab (T) as first-line treatment in patients with unresectable hepatocellular carcinoma (HCC): HIMALAYA study. J Clin Oncol, 2018, 36(15): TPS4144. doi: 10.1200/jco.2018.36.15_suppl.tps4144.
19.	Sun Y, Qin SK, Li W, et al. A randomized, double-blinded, phase Ⅲ study of icaritin versus huachashu as the first-line therapy in biomarker-enriched HBV-related advanced hepatocellular carcinoma with poor conditions: interim analysis result. J Clin Oncol, 2021, 39(15 suppl): abstract 4077. doi: 10.1200/JCO.2021.39.15_suppl.4077.
20.	成遠, 華海清. 欖香烯治療原發性肝癌的研究進展. 臨床腫瘤學雜志, 2017, 22(10): 950-953.
21.	童光武, 高鵬. 消癌平注射液聯合欖香烯注射液治療中晚期原發性肝癌的臨床研究. 現代藥物與臨床, 2016, 31(5): 691-695.
22.	陳乃杰, 吳丹紅, 賴義勤, 等. 消癌平聯合化療治療中晚期肝癌的臨床分析. 光明中醫, 2009, 24(6): 1111-1112.
23.	Ducreux M, Abou-Alfa Gk, Ren Z, et al. Results from a global phase 2 study of tislelizumab, an investigational PD-1 antibody, in patients with previously treated advanced hepatocellular carcinoma. Ann Oncol, 2021, 32(3s): s217.
24.	Qin S, Chen Z, Fang W, et al. Pembrolizumab versus placebo as second-line therapy in patients from Asia with advanced hepatocellular carcinoma: a randomized, double-blind, phase Ⅲ trial. J Clin Oncol, 2022: JCO2200620. doi: 10.1200/JCO.22.00620.
25.	Mei K, Qin S, Chen Z, et al. Camrelizumab in combination with apatinib in second-line or above therapy for advanced primary liver cancer: cohort A report in a multicenter phase Ⅰb/Ⅱ trial. J Immunother Cancer, 2021, 9(3): e002191. doi: 10.1136/jitc-2020-002191.
26.	中華醫學會肝病學分會肝癌學組. HBV/HCV相關肝細胞癌抗病毒治療專家共識 (2021年更新版). 臨床肝膽病雜志, 2021, 37(10): 2292-2302.
27.	中華醫學會肝病學分會肝炎學組, 中華肝臟病雜志. 非一線核苷 (酸) 類似物經治慢性乙型肝炎患者治療策略調整專家共識. 中華肝臟病雜志, 2019, 27(5): 343-346.
28.	Papatheodoridis GV, Idilman R, Dalekos GN, et al. The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B. Hepatology, 2017, 66(5): 1444-1453.
29.	Pawlotsky JM, Negro F, Aghemo A, et al. European association for the study of the liver. EASL recommendations on treatment of hepatitis C 2014. J Hepatol, 2014, 61(2): 373-395.
30.	邱福南, 王耀東, 田毅峰, 等. 阿德福韋酯聯合胸腺肽α1對HBV感染肝細胞癌術后療效的影響. 中華臨床醫師雜志 (電子版), 2010, 4(3): 278-283.
31.	Kim WR, Loomba R, Berg T, et al. Impact of long-term tenofovir disoproxil fumarate on incidence of hepatocellular carcinoma in patients with chronic hepatitis B. Cancer, 2015, 121(20): 3631-3638.
32.	Buti M, Gane E, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol, 2016, 1(3): 196-206.
33.	Chan HL, Fung S, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol, 2016, 1(3): 185-195.
34.	Huang G, Lau WY, Wang ZG, et al. Antiviral therapy improves postoperative survival in patients with hepatocellular carcinoma: a randomized controlled trial. Ann Surg, 2015, 261(1): 56-66.
35.	中華醫學會感染病學分會, 中華醫學會肝病學分會. 慢性乙型肝炎防治指南 (2019年版). 中華傳染病雜志, 2019, 37(12): 711-736.
36.	中華醫學會肝病學分會, 中華醫學會感染病學分會. 丙型肝炎防治指南 (2019年版). 中華臨床感染病雜志, 2019, 12(6): 429-450.
37.	Liu Z, Jin Q, Zhang Y, et al. Randomised clinical trial: 48 weeks of treatment with tenofovir amibufenamide versus tenofovir disoproxil fumarate for patients with chronic hepatitis B. Aliment Pharmacol Ther, 2021, 54(9): 1134-1149.
38.	程能能. 我國首個原研口服抗HBV藥物TMF結構優勢解讀—神奇的甲基化. 肝臟, 2021, 26(12): 1303-1305.
39.	劉桂杰, 王力, 陳硯鑫, 等. TACE聯合干擾素α治療晚期原發性肝癌療效觀察. 山東醫藥, 2010, 50(18): 109-110.
40.	黃得校, 陳勇, 曾慶樂, 等. 大劑量干擾素聯合化療藥物經導管動脈化療栓塞術對肝癌患者T細胞亞群的影響. 廣東醫學, 2013, 34(20): 3185-3188.
41.	張瓊華, 施光峰, 李謙, 等. 甘草酸二銨腸溶膠囊治療慢性肝炎2 396例. 中華傳染病雜志, 2007, 25(3): 175-176.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016. J Natl Cancer Cent, 2022, 2: 1-9.
3. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
4. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
5. Fan R, Papatheodoridis G, Sun J, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. J Hepatol, 2020, 73(6): 1368-1378.
6. Allemani C, Weir HK, Carreira H, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet, 2015, 385(9972): 977-1010.
7. 國家衛生健康委辦公廳. 原發性肝癌診療指南 (2022 年版). 臨床肝膽病雜志, 2022, 38(2): 288-303.
8. 中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療規范 (2019年版). 臨床肝膽病雜志, 2020, 36(2): 277-292.
9. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med, 2020, 382(20): 1894-1905.
10. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 2008, 359(4): 378-390.
11. Qin S, Bai Y, Lim HY, et al. Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia. J Clin Oncol, 2013, 31(28): 3501-3508.
12. 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.
13. Qin S, Bi F, Gu S, et al. Donafenib versus sorafenib in first-line treatment of unresectable or metastatic hepatocellular carcinoma: a randomized, open-label, parallel-controlled phase Ⅱ–Ⅲ trial. J Clin Oncol, 2021, 39(27): 3002-3011.
14. Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet, 2018, 391(10126): 1163-1173.
15. Ren Z, Xu J, Bai Y, et al. Sintilimab plus a bevacizumab biosimilar (IBI305) versus sorafenib in unresectable hepatocellular carcinoma (ORIENT-32): a randomised, open-label, phase 2-3 study. Lancet Oncol, 2021, 22(7): 977-990.
16. Qin S, Ren Z, Meng Z, et al. Camrelizumab in patients with previously treated advanced hepatocellular carcinoma: a multicentre, open-label, parallel-group, randomised, phase 2 trial. Lancet Oncol, 2020, 21(4): 571-580.
17. Ren Z, Qin S, Meng Z, et al. A phase 2 study of camrelizumab for advanced hepatocellular carcinoma: two-year outcomes and continued treatment beyond first RECIST-defined progression. Liver Cancer, 2021, 10(5): 500-509.
18. Abou-Alfa GK, Chan SL, Kudo M, et al. A randomized, multicenter phase 3 study of durvalumab (D) and tremelimumab (T) as first-line treatment in patients with unresectable hepatocellular carcinoma (HCC): HIMALAYA study. J Clin Oncol, 2018, 36(15): TPS4144. doi: 10.1200/jco.2018.36.15_suppl.tps4144.
19. Sun Y, Qin SK, Li W, et al. A randomized, double-blinded, phase Ⅲ study of icaritin versus huachashu as the first-line therapy in biomarker-enriched HBV-related advanced hepatocellular carcinoma with poor conditions: interim analysis result. J Clin Oncol, 2021, 39(15 suppl): abstract 4077. doi: 10.1200/JCO.2021.39.15_suppl.4077.
20. 成遠, 華海清. 欖香烯治療原發性肝癌的研究進展. 臨床腫瘤學雜志, 2017, 22(10): 950-953.
21. 童光武, 高鵬. 消癌平注射液聯合欖香烯注射液治療中晚期原發性肝癌的臨床研究. 現代藥物與臨床, 2016, 31(5): 691-695.
22. 陳乃杰, 吳丹紅, 賴義勤, 等. 消癌平聯合化療治療中晚期肝癌的臨床分析. 光明中醫, 2009, 24(6): 1111-1112.
23. Ducreux M, Abou-Alfa Gk, Ren Z, et al. Results from a global phase 2 study of tislelizumab, an investigational PD-1 antibody, in patients with previously treated advanced hepatocellular carcinoma. Ann Oncol, 2021, 32(3s): s217.
24. Qin S, Chen Z, Fang W, et al. Pembrolizumab versus placebo as second-line therapy in patients from Asia with advanced hepatocellular carcinoma: a randomized, double-blind, phase Ⅲ trial. J Clin Oncol, 2022: JCO2200620. doi: 10.1200/JCO.22.00620.
25. Mei K, Qin S, Chen Z, et al. Camrelizumab in combination with apatinib in second-line or above therapy for advanced primary liver cancer: cohort A report in a multicenter phase Ⅰb/Ⅱ trial. J Immunother Cancer, 2021, 9(3): e002191. doi: 10.1136/jitc-2020-002191.
26. 中華醫學會肝病學分會肝癌學組. HBV/HCV相關肝細胞癌抗病毒治療專家共識 (2021年更新版). 臨床肝膽病雜志, 2021, 37(10): 2292-2302.
27. 中華醫學會肝病學分會肝炎學組, 中華肝臟病雜志. 非一線核苷 (酸) 類似物經治慢性乙型肝炎患者治療策略調整專家共識. 中華肝臟病雜志, 2019, 27(5): 343-346.
28. Papatheodoridis GV, Idilman R, Dalekos GN, et al. The risk of hepatocellular carcinoma decreases after the first 5 years of entecavir or tenofovir in Caucasians with chronic hepatitis B. Hepatology, 2017, 66(5): 1444-1453.
29. Pawlotsky JM, Negro F, Aghemo A, et al. European association for the study of the liver. EASL recommendations on treatment of hepatitis C 2014. J Hepatol, 2014, 61(2): 373-395.
30. 邱福南, 王耀東, 田毅峰, 等. 阿德福韋酯聯合胸腺肽α1對HBV感染肝細胞癌術后療效的影響. 中華臨床醫師雜志 (電子版), 2010, 4(3): 278-283.
31. Kim WR, Loomba R, Berg T, et al. Impact of long-term tenofovir disoproxil fumarate on incidence of hepatocellular carcinoma in patients with chronic hepatitis B. Cancer, 2015, 121(20): 3631-3638.
32. Buti M, Gane E, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol, 2016, 1(3): 196-206.
33. Chan HL, Fung S, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol, 2016, 1(3): 185-195.
34. Huang G, Lau WY, Wang ZG, et al. Antiviral therapy improves postoperative survival in patients with hepatocellular carcinoma: a randomized controlled trial. Ann Surg, 2015, 261(1): 56-66.
35. 中華醫學會感染病學分會, 中華醫學會肝病學分會. 慢性乙型肝炎防治指南 (2019年版). 中華傳染病雜志, 2019, 37(12): 711-736.
36. 中華醫學會肝病學分會, 中華醫學會感染病學分會. 丙型肝炎防治指南 (2019年版). 中華臨床感染病雜志, 2019, 12(6): 429-450.
37. Liu Z, Jin Q, Zhang Y, et al. Randomised clinical trial: 48 weeks of treatment with tenofovir amibufenamide versus tenofovir disoproxil fumarate for patients with chronic hepatitis B. Aliment Pharmacol Ther, 2021, 54(9): 1134-1149.
38. 程能能. 我國首個原研口服抗HBV藥物TMF結構優勢解讀—神奇的甲基化. 肝臟, 2021, 26(12): 1303-1305.
39. 劉桂杰, 王力, 陳硯鑫, 等. TACE聯合干擾素α治療晚期原發性肝癌療效觀察. 山東醫藥, 2010, 50(18): 109-110.
40. 黃得校, 陳勇, 曾慶樂, 等. 大劑量干擾素聯合化療藥物經導管動脈化療栓塞術對肝癌患者T細胞亞群的影響. 廣東醫學, 2013, 34(20): 3185-3188.
41. 張瓊華, 施光峰, 李謙, 等. 甘草酸二銨腸溶膠囊治療慢性肝炎2 396例. 中華傳染病雜志, 2007, 25(3): 175-176.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on guidelines of Chinese Society of Clinical Oncology (CSCO): hepatocellular carcinoma (2022)

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