S3-Leitlinie Diagnostik und Therapie des Hepatozellulären Karzinoms – Kurzversion

Wesentliche Neuerungen

Die Langversion der S3-Leitlinie „Diagnostik und Therapie des Hepatozellulären Karzinoms und der biliären Karzinome“ umfasst zwei Tumorentitäten. Die letzte Version der Leitlinie wurde im August 2023 veröffentlicht.

Folgende wesentliche Änderungen ergeben sich beim Hepatozellulären Karzinom zur S3-Leitlinie von 2023:

• Es wurde die neue Nomenklatur zur MASLD (Metabolic Dysfunction Associated Steatotic Liver Disease; metabolische Dysfunktion assoziierte steatotische Lebererkrankung) anstelle der Nicht-alkoholischen Fettlebererkrankung eingeführt und die NASH wurde dementsprechend zu MASH (metabolic dysfunction-associated steatohepatitis) umbenannt.

• Histopathologische Diagnostik (Kapitel 3.2): Eine bioptische Sicherung wird bei der nicht-zirrhotischen Leber als zentraler Bestandteil der Diagnosestellung empfohlen. Bei der zirrhotischen Leber wird die Bedeutung der Biopsie gestärkt. In der palliativen Situation wird die bioptische Sicherung empfohlen.

• Systemtherapie (Kapitel 3.5):

  • Ergänzung der bereits bekannten Therapieoptionen in der Erstlinie um die Durvalumab-Monotherapie.

  • In einer Child-Pugh B Situation (bis 8 Punkte) wird nun neben Sorafenib auch Lenvatinib empfohlen.

  • Eine Kombination aus einer lokoregionären Therapie und einer Systemtherapie im Stadium BCLC B kann derzeit nicht empfohlen werden.

  • Pädiatrische Patienten in einer fortgeschrittenen Situation sollten in einem molekularen Tumorboard vorgestellt werden.

Das Kapitel Supportivtherapie bezog sich schon in den vorherigen Versionen auf beide Tumorentiäten und wurde bei diesem Update nun an das Ende gestellt (Kapitel 4).

Eine detaillierte Übersicht der Änderungen befindet sich im Kapitel 6.2.

Publication History

Article published online:
10 March 2025

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