Interpretation of “Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer (version-2022)” and “BCLC Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 update”_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Guangzhi ^1,2,3 ,  YAN Lünan ⁴ ,  PENG Tao ^1,2,3

1. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, P. R. China;
2. Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, P. R. China;
3. Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, Nanning 530021, P. R. China;
4. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YAN Lünan, Email: yanlunan688@163.com; PENG Tao, Email: p98720p@163.com

Keywords：

primary liver cancer; guideline interpretation

DOI：

10.7507/1007-9424.202203027

Video：

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“Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer （version-2022）” （China Liver Cancer Staging, Abbreviation “CNLC 2022”） was updated recently and the “Barcelona Clinical Liver Cancer Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 update” （Abbreviation “BCLC 2022”） was also updated in December 2021. The similarities and differences of the two guidelines were interpreted. For the BCLC stage B and C, which are equivalent to CNLC stage Ⅱa and Ⅱb and CNLC stage Ⅲa, respectively, the recommendation of surgical treatment and radiation therapy are disparate in the CNLC 2022 and BCLC 2022. For the systematic treatment of advanced liver cancer, Atezolizumab-Bevacizumab, Renvatinib and Sorafenib were both recommended as the first-line medication in the two guidelines. However, the CNLC 2022 is more flexible than BCLC 2022, which provides more treatment options for Chinese liver cancer patients. It is worth paying attention to two important new concepts proposed in the BCLC 2022: stage migration during treatment and untreatable progression. The BCLC stage B was divided into three subgroups according to tumor burden and liver function and different clinical pathways were recommended in the BCLC 2022.

Citation： ZHU Guangzhi, YAN Lünan, PENG Tao. Interpretation of “Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer (version-2022)” and “BCLC Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 update”. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(4): 434-439. doi: 10.7507/1007-9424.202203027 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2.	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.
3.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版). 中国实用外科杂志, 2022, 42(3): 241-273.
4.	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.
5.	Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
6.	Zhou J, Yu L, Gao X, et al. Plasma microRNA panel to diagnose hepatitis B virus-related hepatocellular carcinoma. J Clin Oncol, 2011, 29(36): 4781-4788.
7.	Best J, Bechmann LP, Sowa JP, et al. GALAD score detects early hepatocellular carcinoma in an international cohort of patients with nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol, 2020, 18(3): 728-735.
8.	He MK, Liang RB, Zhao Y, et al. Lenvatinib, toripalimab, plus hepatic arterial infusion chemotherapy versus lenvatinib alone for advanced hepatocellular carcinoma. Ther Adv Med Oncol, 2021, 13: 17588359211002720. doi: 10.1177/17588359211002720.
9.	Wu JY, Yin ZY, Bai YN, et al. Lenvatinib combined with anti-PD-1 antibodies plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a multicenter retrospective study. J Hepatocell Carcinoma, 2021, 8: 1233-1240.
10.	He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: a randomized clinical trial. JAMA Oncol, 2019, 5(7): 953-960.
11.	Wei X, Jiang Y, Zhang X, et al. Neoadjuvant three-dimensional conformal radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: a randomized, open-label, multicenter controlled study. J Clin Oncol, 2019, 37(24): 2141-2151.
12.	Kaseb AO, Cao HST, Mohamed YI, et al. Final results of a randomized, open label, perioperative phase Ⅱ study evaluating nivolumab alone or nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol, 2020, 38（15_suppl）: 4599. doi: 10.1200/JCO.2020.38.15_suppl.4599.
13.	Galle PR, Finn RS, Qin S, et al. Patient-reported outcomes with atezolizumab plus bevacizumab versus sorafenib in patients with unresectable hepatocellular carcinoma (IMbrave150): an open-label, randomised, phase 3 trial. Lancet Oncol, 2021, 22(7): 991-1001.
14.	Kaseb AO, Hasanov E, Cao HST, et al. Perioperative nivolumab monotherapy versus nivolumab plus ipilimumab in resectable hepatocellular carcinoma: a randomised, open-label, phase 2 trial. Lancet Gastroenterol Hepatol, 2022, 7(3): 208-218.
15.	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.
16.	Mazzaferro V, Citterio D, Bhoori S, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial. Lancet Oncol, 2020, 21(7): 947-956.
17.	Li QJ, He MK, Chen HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: a randomized phase Ⅲ trial. J Clin Oncol, 2022, 40(2): 150-160.
18.	Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med, 2020, 382(20): 1894-1905.
19.	Qin S, Ren Z, Feng YH, et al. Atezolizumab plus bevacizumab versus sorafenib in the Chinese subpopulation with unresectable hepatocellular carcinoma: phase 3 randomized, open-label IMbrave150 study. Liver Cancer, 2021, 10(4): 296-308.
20.	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.
21.	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.
22.	Qin S, Li Q, Gu S, et al. Apatinib as second-line or later therapy in patients with advanced hepatocellular carcinoma (AHELP): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol, 2021, 6(7): 559-568.
23.	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.
24.	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.
25.	Qin S, Finn RS, Kudo M, et al. RATIONALE 301 study: tislelizumab versus sorafenib as first-line treatment for unresectable hepatocellular carcinoma. Future Oncol, 2019, 15(16): 1811-1822.
26.	Zhu AX, Finn RS, Edeline J, et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol, 2018, 19(7): 940-952.
27.	Yau T, Kang YK, Kim TY, et al. Efficacy and safety of nivolumab plus ipilimumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib: the CheckMate 040 randomized clinical trial. JAMA Oncol, 2020, 6（11）: e204564. doi: 10.1001/jamaoncol.2020.4564.
28.	Abou-Alfa GK, Meyer T, Cheng AL, et al. Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med, 2018, 379(1): 54-63.
29.	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.
30.	Sørensen JB, Klee M, Palshof T, et al. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer, 1993, 67(4): 773-775.
31.	Pinato DJ, Sharma R, Allara E, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol, 2017, 66(2): 338-346.
32.	Singal AG, Hoshida Y, Pinato DJ, et al. International liver cancer association (ILCA) white paper on biomarker development for hepatocellular carcinoma. Gastroenterology, 2021, 160(7): 2572-2584.
33.	Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The model for end-stage liver disease updated for the modern era. Gastroenterology, 2021, 161(6): 1887-1895.
34.	Reig M, Darnell A, Forner A, et al. Systemic therapy for hepatocellular carcinoma: the issue of treatment stage migration and registration of progression using the BCLC-refined RECIST. Semin Liver Dis, 2014, 34(4): 444-455.
35.	Forner A, Gilabert M, Bruix J, et al. Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol, 2014, 11(9): 525-535.
36.	Templeton AJ, Amir E, Tannock IF. Informative censoring—a neglected cause of bias in oncology trials. Nat Rev Clin Oncol, 2020, 17(6): 327-328.
37.	Zhong JH, Ke Y, Gong WF, et al. Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma. Ann Surg, 2014, 260(2): 329-340.
38.	Zhaohui Z, Shunli S, Bin C, et al. Hepatic resection provides survival benefit for selected intermediate-stage (BCLC-B) hepatocellular carcinoma patients. Cancer Res Treat, 2019, 51(1): 65-72.
39.	Xu X, Lu D, Ling Q, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Gut, 2016, 65(6): 1035-1041.
40.	Duvoux C, Roudot-Thoraval F, Decaens T, et al. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria. Gastroenterology, 2012, 143(4): 986-994.
41.	Mazzaferro V, Sposito C, Zhou J, et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma. Gastroenterology, 2018, 154(1): 128-139.
42.	Hameed B, Mehta N, Sapisochin G, et al. Alpha-fetoprotein level > 1 000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl, 2014, 20(8): 945-951.
43.	Kim TH, Koh YH, Kim BH, et al. Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma:A randomized phase Ⅲ trial. J Hepatol, 2021, 74(3): 603-612.
44.	Yoon SM, Ryoo BY, Lee SJ, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol, 2018, 4(5): 661-669.
45.	Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2019, 30(5): 871-873.
46.	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.
47.	Qin S, Cheng Y, Liang J, et al. Efficacy and safety of the FOLFOX4 regimen versus doxorubicin in Chinese patients with advanced hepatocellular carcinoma: a subgroup analysis of the EACH study. Oncologist, 2014, 19(11): 1169-1178.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. 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.
3. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版). 中国实用外科杂志, 2022, 42(3): 241-273.
4. 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.
5. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
6. Zhou J, Yu L, Gao X, et al. Plasma microRNA panel to diagnose hepatitis B virus-related hepatocellular carcinoma. J Clin Oncol, 2011, 29(36): 4781-4788.
7. Best J, Bechmann LP, Sowa JP, et al. GALAD score detects early hepatocellular carcinoma in an international cohort of patients with nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol, 2020, 18(3): 728-735.
8. He MK, Liang RB, Zhao Y, et al. Lenvatinib, toripalimab, plus hepatic arterial infusion chemotherapy versus lenvatinib alone for advanced hepatocellular carcinoma. Ther Adv Med Oncol, 2021, 13: 17588359211002720. doi: 10.1177/17588359211002720.
9. Wu JY, Yin ZY, Bai YN, et al. Lenvatinib combined with anti-PD-1 antibodies plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a multicenter retrospective study. J Hepatocell Carcinoma, 2021, 8: 1233-1240.
10. He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: a randomized clinical trial. JAMA Oncol, 2019, 5(7): 953-960.
11. Wei X, Jiang Y, Zhang X, et al. Neoadjuvant three-dimensional conformal radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: a randomized, open-label, multicenter controlled study. J Clin Oncol, 2019, 37(24): 2141-2151.
12. Kaseb AO, Cao HST, Mohamed YI, et al. Final results of a randomized, open label, perioperative phase Ⅱ study evaluating nivolumab alone or nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol, 2020, 38（15_suppl）: 4599. doi: 10.1200/JCO.2020.38.15_suppl.4599.
13. Galle PR, Finn RS, Qin S, et al. Patient-reported outcomes with atezolizumab plus bevacizumab versus sorafenib in patients with unresectable hepatocellular carcinoma (IMbrave150): an open-label, randomised, phase 3 trial. Lancet Oncol, 2021, 22(7): 991-1001.
14. Kaseb AO, Hasanov E, Cao HST, et al. Perioperative nivolumab monotherapy versus nivolumab plus ipilimumab in resectable hepatocellular carcinoma: a randomised, open-label, phase 2 trial. Lancet Gastroenterol Hepatol, 2022, 7(3): 208-218.
15. 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.
16. Mazzaferro V, Citterio D, Bhoori S, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial. Lancet Oncol, 2020, 21(7): 947-956.
17. Li QJ, He MK, Chen HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: a randomized phase Ⅲ trial. J Clin Oncol, 2022, 40(2): 150-160.
18. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med, 2020, 382(20): 1894-1905.
19. Qin S, Ren Z, Feng YH, et al. Atezolizumab plus bevacizumab versus sorafenib in the Chinese subpopulation with unresectable hepatocellular carcinoma: phase 3 randomized, open-label IMbrave150 study. Liver Cancer, 2021, 10(4): 296-308.
20. 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.
21. 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.
22. Qin S, Li Q, Gu S, et al. Apatinib as second-line or later therapy in patients with advanced hepatocellular carcinoma (AHELP): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol, 2021, 6(7): 559-568.
23. 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.
24. 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.
25. Qin S, Finn RS, Kudo M, et al. RATIONALE 301 study: tislelizumab versus sorafenib as first-line treatment for unresectable hepatocellular carcinoma. Future Oncol, 2019, 15(16): 1811-1822.
26. Zhu AX, Finn RS, Edeline J, et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol, 2018, 19(7): 940-952.
27. Yau T, Kang YK, Kim TY, et al. Efficacy and safety of nivolumab plus ipilimumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib: the CheckMate 040 randomized clinical trial. JAMA Oncol, 2020, 6（11）: e204564. doi: 10.1001/jamaoncol.2020.4564.
28. Abou-Alfa GK, Meyer T, Cheng AL, et al. Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med, 2018, 379(1): 54-63.
29. 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.
30. Sørensen JB, Klee M, Palshof T, et al. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer, 1993, 67(4): 773-775.
31. Pinato DJ, Sharma R, Allara E, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol, 2017, 66(2): 338-346.
32. Singal AG, Hoshida Y, Pinato DJ, et al. International liver cancer association (ILCA) white paper on biomarker development for hepatocellular carcinoma. Gastroenterology, 2021, 160(7): 2572-2584.
33. Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The model for end-stage liver disease updated for the modern era. Gastroenterology, 2021, 161(6): 1887-1895.
34. Reig M, Darnell A, Forner A, et al. Systemic therapy for hepatocellular carcinoma: the issue of treatment stage migration and registration of progression using the BCLC-refined RECIST. Semin Liver Dis, 2014, 34(4): 444-455.
35. Forner A, Gilabert M, Bruix J, et al. Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol, 2014, 11(9): 525-535.
36. Templeton AJ, Amir E, Tannock IF. Informative censoring—a neglected cause of bias in oncology trials. Nat Rev Clin Oncol, 2020, 17(6): 327-328.
37. Zhong JH, Ke Y, Gong WF, et al. Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma. Ann Surg, 2014, 260(2): 329-340.
38. Zhaohui Z, Shunli S, Bin C, et al. Hepatic resection provides survival benefit for selected intermediate-stage (BCLC-B) hepatocellular carcinoma patients. Cancer Res Treat, 2019, 51(1): 65-72.
39. Xu X, Lu D, Ling Q, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Gut, 2016, 65(6): 1035-1041.
40. Duvoux C, Roudot-Thoraval F, Decaens T, et al. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria. Gastroenterology, 2012, 143(4): 986-994.
41. Mazzaferro V, Sposito C, Zhou J, et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma. Gastroenterology, 2018, 154(1): 128-139.
42. Hameed B, Mehta N, Sapisochin G, et al. Alpha-fetoprotein level > 1 000 ng/mL as an exclusion criterion for liver transplantation in patients with hepatocellular carcinoma meeting the Milan criteria. Liver Transpl, 2014, 20(8): 945-951.
43. Kim TH, Koh YH, Kim BH, et al. Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma:A randomized phase Ⅲ trial. J Hepatol, 2021, 74(3): 603-612.
44. Yoon SM, Ryoo BY, Lee SJ, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol, 2018, 4(5): 661-669.
45. Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2019, 30(5): 871-873.
46. 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.
47. Qin S, Cheng Y, Liang J, et al. Efficacy and safety of the FOLFOX4 regimen versus doxorubicin in Chinese patients with advanced hepatocellular carcinoma: a subgroup analysis of the EACH study. Oncologist, 2014, 19(11): 1169-1178.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Interpretation of “Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer (version-2022)” and “BCLC Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 update”

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