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.	国家卫生健康委办公厅. 原发性肝癌诊疗指南 (2022 年版). 临床肝胆病杂志, 2022, 38(2): 288-303.
8.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范 (2019年版). 临床肝胆病杂志, 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.	成远, 华海清. 榄香烯治疗原发性肝癌的研究进展. 临床肿瘤学杂志, 2017, 22(10): 950-953.
21.	童光武, 高鹏. 消癌平注射液联合榄香烯注射液治疗中晚期原发性肝癌的临床研究. 现代药物与临床, 2016, 31(5): 691-695.
22.	陈乃杰, 吴丹红, 赖义勤, 等. 消癌平联合化疗治疗中晚期肝癌的临床分析. 光明中医, 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.	中华医学会肝病学分会肝癌学组. HBV/HCV相关肝细胞癌抗病毒治疗专家共识 (2021年更新版). 临床肝胆病杂志, 2021, 37(10): 2292-2302.
27.	中华医学会肝病学分会肝炎学组, 中华肝脏病杂志. 非一线核苷 (酸) 类似物经治慢性乙型肝炎患者治疗策略调整专家共识. 中华肝脏病杂志, 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, 王耀东, 田毅峰, 等. 阿德福韦酯联合胸腺肽α1对HBV感染肝细胞癌术后疗效的影响. 中华临床医师杂志 (电子版), 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.	中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南 (2019年版). 中华传染病杂志, 2019, 37(12): 711-736.
36.	中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南 (2019年版). 中华临床感染病杂志, 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. 我国首个原研口服抗HBV药物TMF结构优势解读—神奇的甲基化. 肝脏, 2021, 26(12): 1303-1305.
39.	刘桂杰, 王力, 陈砚鑫, 等. TACE联合干扰素α治疗晚期原发性肝癌疗效观察. 山东医药, 2010, 50(18): 109-110.
40.	黄得校, 陈勇, 曾庆乐, 等. 大剂量干扰素联合化疗药物经导管动脉化疗栓塞术对肝癌患者T细胞亚群的影响. 广东医学, 2013, 34(20): 3185-3188.
41.	张琼华, 施光峰, 李谦, 等. 甘草酸二铵肠溶胶囊治疗慢性肝炎2 396例. 中华传染病杂志, 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. 国家卫生健康委办公厅. 原发性肝癌诊疗指南 (2022 年版). 临床肝胆病杂志, 2022, 38(2): 288-303.
8. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范 (2019年版). 临床肝胆病杂志, 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. 成远, 华海清. 榄香烯治疗原发性肝癌的研究进展. 临床肿瘤学杂志, 2017, 22(10): 950-953.
21. 童光武, 高鹏. 消癌平注射液联合榄香烯注射液治疗中晚期原发性肝癌的临床研究. 现代药物与临床, 2016, 31(5): 691-695.
22. 陈乃杰, 吴丹红, 赖义勤, 等. 消癌平联合化疗治疗中晚期肝癌的临床分析. 光明中医, 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. 中华医学会肝病学分会肝癌学组. HBV/HCV相关肝细胞癌抗病毒治疗专家共识 (2021年更新版). 临床肝胆病杂志, 2021, 37(10): 2292-2302.
27. 中华医学会肝病学分会肝炎学组, 中华肝脏病杂志. 非一线核苷 (酸) 类似物经治慢性乙型肝炎患者治疗策略调整专家共识. 中华肝脏病杂志, 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, 王耀东, 田毅峰, 等. 阿德福韦酯联合胸腺肽α1对HBV感染肝细胞癌术后疗效的影响. 中华临床医师杂志 (电子版), 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. 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南 (2019年版). 中华传染病杂志, 2019, 37(12): 711-736.
36. 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南 (2019年版). 中华临床感染病杂志, 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. 我国首个原研口服抗HBV药物TMF结构优势解读—神奇的甲基化. 肝脏, 2021, 26(12): 1303-1305.
39. 刘桂杰, 王力, 陈砚鑫, 等. TACE联合干扰素α治疗晚期原发性肝癌疗效观察. 山东医药, 2010, 50(18): 109-110.
40. 黄得校, 陈勇, 曾庆乐, 等. 大剂量干扰素联合化疗药物经导管动脉化疗栓塞术对肝癌患者T细胞亚群的影响. 广东医学, 2013, 34(20): 3185-3188.
41. 张琼华, 施光峰, 李谦, 等. 甘草酸二铵肠溶胶囊治疗慢性肝炎2 396例. 中华传染病杂志, 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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