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Digestive Disease Interventions 2024; 08(03): 173-182
DOI: 10.1055/s-0044-1788691
Review Article

Current Trends in Hepatocellular Carcinoma Therapies in China

Ying Zhang   *
1   Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
2   Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, China
,
Yong Wang   *
1   Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
2   Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, China
,
Jin-He Guo 
1   Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
2   Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, China
,
Jian Lu 
1   Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
2   Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, China
› Author Affiliations Funding The study was supported by Jiangsu Provincial Special Program of Medical Science (BE2022855), ZhiShan Scholar Program of Southeast University (2242022R40069), and National Key Research and Development Program (2018YFA0704100, 2018YFA0704104) and Research Personnel Cultivation Programme of Zhongda Hospital Southeast University (CZXM-GSP-RC124). The funders of the article had no role in the study protocol design, data analysis, interpretation, or manuscript writing.
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Abstract

Hepatocellular carcinoma (HCC) is a malignant tumor that is particularly prevalent in China, making up almost 50% of HCC cases worldwide. Compared to HCC patients in Europe, North America, and the Asia-Pacific region, Chinese patients exhibit unique characteristics in etiology, demographics (age, gender, geographic location, economic status), biological behavior, treatment options, and prognosis. While hepatitis B virus remains a primary cause of HCC in China, there is a growing trend of alcoholic liver disease and nonalcoholic fatty liver disease in the country. A special pathological staging guidance distribution of therapies for HCC was developed by the Chinese Medical Association. In China, there is a diverse array of therapeutic options for treating HCC, including liver resection, liver transplantation, intra-arterial therapies, ablation, radiotherapies, systemic therapies, and traditional Chinese medicine. The treatment of HCC has multiple permutations and combinations of modalities. Due to the varying stages of HCC and individual patient differences, the multidisciplinary team model is often necessary to tailor treatment strategies and optimize clinical outcomes. Meanwhile, to enhance survival benefits and effectively improve the prognosis and life quality of patients with HCC, Chinese experts are actively engaged in conducting clinical trials to identify potential beneficiary populations. This review aims to elaborate on the therapeutic features of HCC in China to present to the world the innovative approaches and comprehensive care offered to Chinese HCC patients.

Keywords

hepatocellular carcinoma - therapies - multidisciplinary team

* Contributed equally as joint first authors.




Publication History

Article published online:
26 August 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Singal AG, Kanwal F, Llovet JM. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nat Rev Clin Oncol 2023; 20 (12) 864-884
    CrossrefPubMedSearch in Google Scholar
  • 2 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin 2021; 71 (01) 7-33
    CrossrefPubMedSearch in Google Scholar
  • 3 Cao M, Li H, Sun D, Chen W. Cancer burden of major cancers in China: a need for sustainable actions. Cancer Commun (Lond) 2020; 40 (05) 205-210
    CrossrefPubMedSearch in Google Scholar
  • 4 Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin 2012; 62 (06) 394-399
    CrossrefPubMedSearch in Google Scholar
  • 5 Zhou J, Sun H, Wang Z. et al. Guidelines for the diagnosis and treatment of primary liver cancer (2022 edition). Liver Cancer 2023; 12 (05) 405-444
    CrossrefPubMedSearch in Google Scholar
  • 6 Qi J, Li M, Wang L. et al. National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data. Lancet Public Health 2023; 8 (12) e943-e955
    CrossrefPubMedSearch in Google Scholar
  • 7 Arnold M, Abnet CC, Neale RE. et al. Global burden of 5 major types of gastrointestinal cancer. Gastroenterology 2020; 159 (01) 335-349.e15
    CrossrefPubMedSearch in Google Scholar
  • 8 Chen W, Sun K, Zheng R. et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res 2018; 30 (01) 1-12
    CrossrefPubMedSearch in Google Scholar
  • 9 Ferlay J, Ervik M, Lam F. et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; Accessed July 12, 2024 at: https://gco.iarc.who.int/today Published online 2024
  • 10 International Agency for Research on Cancer. Accessed July 12, 2024 at: https://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf Published online 2020
    PubMed
  • 11 Chen W, Zheng R, Baade PD. et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016; 66 (02) 115-132
    CrossrefPubMedSearch in Google Scholar
  • 12 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
    CrossrefPubMedSearch in Google Scholar
  • 13 Guidelines of Chinese Society of Clinical Oncology(CSCO). Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition). People's Medical Publishing House. Published online 2022:11–157
    PubMed
  • 14 Zeng H, Chen W, Zheng R. et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health 2018; 6 (05) e555-e567
    CrossrefPubMedSearch in Google Scholar
  • 15 Allemani C, Weir HK, Carreira H. et al; CONCORD Working Group. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015; 385 (9972): 977-1010
    CrossrefPubMedSearch in Google Scholar
  • 16 Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65 (02) 87-108
    CrossrefPubMedSearch in Google Scholar
  • 17 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 (03) 209-249
    CrossrefPubMedSearch in Google Scholar
  • 18 Chen LT, Martinelli E, Cheng AL. et al. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with intermediate and advanced/relapsed hepatocellular carcinoma: a TOS-ESMO initiative endorsed by CSCO, ISMPO, JSMO, KSMO, MOS and SSO. Ann Oncol 2020; 31 (03) 334-351
    CrossrefPubMedSearch in Google Scholar
  • 19 Chen T, Liu J, Li Y, Wei S. Burden of disease associated with dietary exposure to aflatoxins in China in 2020. Nutrients 2022; 14 (05) 1027
    CrossrefPubMedSearch in Google Scholar
  • 20 Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet 2021; 398 (10308): 1359-1376
    CrossrefPubMedSearch in Google Scholar
  • 21 Tan DJH, Setiawan VW, Ng CH. et al. Global burden of liver cancer in males and females: changing etiological basis and the growing contribution of NASH. Hepatology 2023; 77 (04) 1150-1163
    CrossrefPubMedSearch in Google Scholar
  • 22 Huang DQ, Tan DJH, Ng CH. et al. Hepatocellular carcinoma incidence in alcohol-associated cirrhosis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2023; 21 (05) 1169-1177
    CrossrefPubMedSearch in Google Scholar
  • 23 Tan DJH, Ng CH, Lin SY. et al. Clinical characteristics, surveillance, treatment allocation, and outcomes of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a systematic review and meta-analysis. Lancet Oncol 2022; 23 (04) 521-530
    CrossrefPubMedSearch in Google Scholar
  • 24 He J, Chen W, Shen H. et al. China guideline for liver cancer screening (2022, Beijing). Zhonghua Xiaohua Waike Zazhi 2022; 44 (08) 779-814
    PubMedSearch in Google Scholar
  • 25 Zhou J, Sun HC, Wang Z. et al. Guidelines for diagnosis and treatment of primary liver cancer in China (2017 edition). Liver Cancer 2018; 7 (03) 235-260
    CrossrefPubMedSearch in Google Scholar
  • 26 Yau T, Tang VYF, Yao TJ, Fan ST, Lo CM, Poon RTP. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 2014; 146 (07) 1691-700.e3
    CrossrefPubMedSearch in Google Scholar
  • 27 Chun YS, Pawlik TM, Vauthey JN. 8th Edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol 2018; 25 (04) 845-847
    CrossrefPubMedSearch in Google Scholar
  • 28 National Health Commission of the People's, Republic of China. Guidelines for the diagnosis and treatment of primary hepatic carcinoma (2022 edition). Journal of Multidisciplinary Cancer Management 2022; 8 (02) 16-53 (Electronic Version)
    PubMedSearch in Google Scholar
  • 29 Yin L, Li H, Li AJ. et al. Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: a RCT. J Hepatol 2014; 61 (01) 82-88
    CrossrefPubMedSearch in Google Scholar
  • 30 Zhong JH, Ke Y, Gong W-F. et al. Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma. Ann Surg 2014; 260 (02) 329-340
    CrossrefPubMedSearch in Google Scholar
  • 31 Chinese Association of Liver Cancer of Chinese Medical Doctor Association. Chinese expert consensus on the diagnosis and treatment of hepatocellular carcinoma with microvascular invasion (2024 edition). Zhonghua Xiaohua Waike Zazhi 2024; 23 (02) 153-164
    PubMedSearch in Google Scholar
  • 32 Bai S, Yang P, Xie Z. et al. Preoperative estimated risk of microvascular invasion is associated with prognostic differences following liver resection versus radiofrequency ablation for early hepatitis B virus-related hepatocellular carcinoma. Ann Surg Oncol 2021; 28 (13) 8174-8185
    CrossrefPubMedSearch in Google Scholar
  • 33 Committee of Liver Surgeons, Chinese Congress of Surgeons, Chinese Medical Doctor Association. Chinese expert consensus on the application of indocyanine green near-infrared imaging technology in liver surgery (2023 edition). Chin J Pra Surg 2023; 43 (04) 371-383
    PubMedSearch in Google Scholar
  • 34 Chinese Society of Digital Medicine. Chinese Medical Association, Liver Cancer Committee of Chinese Medical Doctor Association, Chinese Society of Minimally Invasive Surgery, Chinese College of Surgeons, Chinese Medical Doctor Association, Digital Intelligent Surgery Committee of Chinese Research Hospital Association. Chinese expert consensus on hepatectomy navigated by indocyanine green fluorescence combined with digital intelligent (version 2021). Chin J Pra Surg 2022; 42 (03) 274-284
    PubMedSearch in Google Scholar
  • 35 Chinese Association of Liver Cancer of Chinese Medical Doctor Association. Chinese guidelines for the diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus (2021 edition). Zhonghua Yi Xue Za Zhi 2022; 102 (04) 243-254
    PubMedSearch in Google Scholar
  • 36 Alliance of Chinese Expert Consensus on Neoadjuvant Therapy for Hepatocellular Carcinoma, Committee of Digestive Surgery of Chinese Research Hospital Association, Committee of Liver Cancer, Chinese Anti-Cancer Association. [Chinese expert consensus on neoadjuvant therapy for hepatocellular carcinoma (2023 edition)]. Zhonghua Wai Ke Za Zhi 2023; 61 (12) 1035-1045
    PubMedSearch in Google Scholar
  • 37 Zhu X, Jian Z. Consensus and controversies of neoadjuvant therapy for primary liver cancer. Chin J Pra Surg. 2023; 43 (04) 286-290 , 309
    PubMedSearch in Google Scholar
  • 38 Alliance of Chinese Expert Consensus on Postoperative Adjuvant Therapy for Hepatocellular Carcinoma, Chinese College of Surgeons, Committee of Liver Cancer, Chinese Anti-Cancer Association, Liver Cancer Group, Society of Oncology, Chinese Medical Association. Chinese expert consensus on postoperative adjuvant therapy for hepatocellular carcinoma (2023 edition). Zhonghua Xiaohua Waike Zazhi 2023; 22 (04) 437-448
    PubMedSearch in Google Scholar
  • 39 Zheng S, Shu L, Xu X. Chinese College of Transplant Doctors LTG, Chinese Society of Organ Transplantation CMA. Chinese clinical practice guidelines on liver transplantation for hepatocellular carcinoma (2021 edition). Zhonghua Xiaohua Waike Zazhi 2023; 21 (04) 433-443
    PubMedSearch in Google Scholar
  • 40 Xu X, Lu D, Ling Q. et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Gut 2016; 65 (06) 1035-1041
    CrossrefPubMedSearch in Google Scholar
  • 41 Park JW, Chen M, Colombo M. et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 2015; 35 (09) 2155-2166
    CrossrefPubMedSearch in Google Scholar
  • 42 Jiang G, Ling S, Zhan Q, Zhuang L, Xu X. Downstaging treatment for patients with hepatocellular carcinoma before transplantation. Transplant Rev (Orlando) 2021; 35 (02) 100606
    CrossrefPubMedSearch in Google Scholar
  • 43 Shi GM, Wang J, Huang XW. et al. Graft programmed death ligand 1 expression as a marker for transplant rejection following anti-programmed death 1 immunotherapy for recurrent liver tumors. Liver Transpl 2021; 27 (03) 444-449
    CrossrefPubMedSearch in Google Scholar
  • 44 Nordness MF, Hamel S, Godfrey CM. et al. Fatal hepatic necrosis after nivolumab as a bridge to liver transplant for HCC: Are checkpoint inhibitors safe for the pretransplant patient?. Am J Transplant 2020; 20 (03) 879-883
    CrossrefPubMedSearch in Google Scholar
  • 45 Chen J, Shen T, Li J. et al. Clinical practice guideline on liver transplantation for hepatocellular carcinoma in China (2021 edition). Chin Med J (Engl) 2022; 135 (24) 2911-2913
    PubMedSearch in Google Scholar
  • 46 Mazzaferro V, Regalia E, Doci R. et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334 (11) 693-699
    CrossrefPubMedSearch in Google Scholar
  • 47 Xu X, Pu X, Jiang L. et al. Living donor liver transplantation or hepatic resection combined with intraoperative radiofrequency ablation for Child-Pugh A hepatocellular carcinoma patient with multifocal tumours meeting the University of California San Francisco (UCSF) criteria. J Cancer Res Clin Oncol 2021; 147 (02) 607-618
    CrossrefPubMedSearch in Google Scholar
  • 48 Yao FY, Ferrell L, Bass NM. et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33 (06) 1394-1403
    CrossrefPubMedSearch in Google Scholar
  • 49 Qu LS, Liu JX, Zhu J, Lu CH. Risk factors for prognosis of hepatocellular carcinoma after curative resection in patients with low hepatitis B viral load. Ann Hepatol 2017; 16 (03) 412-420
    CrossrefPubMedSearch in Google Scholar
  • 50 Xu X, Yang J, Zhong L. et al. The clinical value of “Hangzhou Criteria” in the selection of patients with hepatocellular carcinoma for liver transplantation: a report of l 163 cases on a multi-center basis. Chin J Organ Transplant. 2013; 34 (09) 524-527
    PubMedSearch in Google Scholar
  • 51 Audet M, Panaro F, Piardi T, Wolf P. Are the Hangzhou criteria adaptable to hepatocellular carcinoma patients for liver transplantation in Western countries?. Liver Transpl 2009; 15 (07) 822-823 , author reply 824–826
    CrossrefPubMedSearch in Google Scholar
  • 52 Lu J, Zhao M, Arai Y. et al; International Society of Multidisciplinary Interventional Oncology (ISMIO). Clinical practice of transarterial chemoembolization for hepatocellular carcinoma: consensus statement from an international expert panel of International Society of Multidisciplinary Interventional Oncology (ISMIO). Hepatobiliary Surg Nutr 2021; 10 (05) 661-671
    CrossrefPubMedSearch in Google Scholar
  • 53 Ikeda M, Kudo M, Aikata H. et al; Miriplatin TACE Study Group. Transarterial chemoembolization with miriplatin vs. epirubicin for unresectable hepatocellular carcinoma: a phase III randomized trial. J Gastroenterol 2018; 53 (02) 281-290
    CrossrefPubMedSearch in Google Scholar
  • 54 Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind JFH. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology 2016; 64 (01) 106-116
    CrossrefPubMedSearch in Google Scholar
  • 55 Teng G, Liu R, Zhu H. et al; Clinical Guidelines Committee of Chinese College of Interventionalists. [Chinese clinical practice guidelines for transarterial chemoembolization of hepatocellular carcinoma (2023 edition)]. Zhonghua Yi Xue Za Zhi 2023; 103 (34) 2674-2694
    PubMedSearch in Google Scholar
  • 56 Zhou W, Yuan S. Research advances in conversion therapy for hepatocellular carcinoma. Zhonghua Xiaohua Waike Zazhi 2020; 19 (02) 130-134
    PubMedSearch in Google Scholar
  • 57 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL clinical practice guidelines: liver transplantation. J Hepatol 2016; 64 (02) 433-485
    CrossrefPubMedSearch in Google Scholar
  • 58 Zhu K, Chen J, Lai L. et al. Hepatocellular carcinoma with portal vein tumor thrombus: treatment with transarterial chemoembolization combined with sorafenib – a retrospective controlled study. Radiology 2014; 272 (01) 284-293
    CrossrefPubMedSearch in Google Scholar
  • 59 Lu J, Zhang XP, Zhong BY. et al. Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west. Lancet Gastroenterol Hepatol 2019; 4 (09) 721-730
    CrossrefPubMedSearch in Google Scholar
  • 60 Chung GE, Lee JH, Kim HY. et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 2011; 258 (02) 627-634
    CrossrefPubMedSearch in Google Scholar
  • 61 Silva JP, Berger NG, Tsai S. et al. Transarterial chemoembolization in hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis. HPB (Oxford) 2017; 19 (08) 659-666
    CrossrefPubMedSearch in Google Scholar
  • 62 Guo Z, Teng G, Zou Y. et al. Transarterial treatment of primary and secondary liver cancer with drug-eluting beads transarterial chemoembolization:technical recommendations. Zhonghua Fang She Xue Za Zhi 2019; 53 (05) 336-340
    PubMedSearch in Google Scholar
  • 63 Chinese Society of Liver Cancer, China Anti-Cancer Association. Chinese expert consensus on hepatic arterial infusion chemotherapy for hepatocellular carcinoma (2021 edition). Zhonghua Xiaohua Waike Zazhi 2021; 20 (07) 754-759
    PubMedSearch in Google Scholar
  • 64 Kudo M, Matsui O, Izumi N. et al; Liver Cancer Study Group of Japan. JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan. Liver Cancer 2014; 3 (3-4): 458-468
    CrossrefPubMedSearch in Google Scholar
  • 65 Zhao M, Guo Z, Zou YH. et al. Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations. Hepatol Int 2024; 18 (01) 4-31
    CrossrefPubMedSearch in Google Scholar
  • 66 Lyu N, Kong Y, Mu L. et al. Hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin vs. sorafenib for advanced hepatocellular carcinoma. J Hepatol 2018; 69 (01) 60-69
    CrossrefPubMedSearch in Google Scholar
  • 67 Lyu N, Lin Y, Kong Y. et al. FOXAI: a phase II trial evaluating the efficacy and safety of hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin for advanced hepatocellular carcinoma. Gut 2018; 67 (02) 395-396
    PubMedSearch in Google Scholar
  • 68 He MK, Le Y, Li QJ. et al. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer 2017; 36 (01) 83
    CrossrefPubMedSearch in Google Scholar
  • 69 Lyu N, Wang X, Li JB. et al. Arterial chemotherapy of oxaliplatin plus fluorouracil versus sorafenib in advanced hepatocellular carcinoma: a biomolecular exploratory, randomized, phase III trial (FOHAIC-1). J Clin Oncol 2022; 40 (05) 468-480
    CrossrefPubMedSearch in Google Scholar
  • 70 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 (07) 953-960
    CrossrefPubMedSearch in Google Scholar
  • 71 Li SH, Mei J, Cheng Y. et al. Postoperative adjuvant hepatic arterial infusion chemotherapy with FOLFOX in hepatocellular carcinoma with microvascular invasion: a multicenter, phase III, randomized study. J Clin Oncol 2023; 41 (10) 1898-1908
    CrossrefPubMedSearch in Google Scholar
  • 72 Writing Group of Chinese Society of Interventional Radiology. Technical standards of transcatheter arterial chemoembolization for hepatocellular carcinoma: experts common opinion. Zhonghua Fang She Xue Za Zhi 2011; 45 (10) 908-912
    PubMedSearch in Google Scholar
  • 73 Zhao D, Zhang L, Jiang X, Shi Y, Yan Z, Ni C. Is HAIC an obsolete technology or a novel therapeutic method? HAIC should be treated rationally. J Intervent Radiol 2022; 31 (01) 2-8
    PubMedSearch in Google Scholar
  • 74 Song L, Zou Y. Experts consensus on management of yttrium 90 microspheres. Zhongguo Jieru Yingxiang Yu Zhiliaoxue 2021; 18 (06) 321-325
    PubMedSearch in Google Scholar
  • 75 National Medical Products Administration. Yttrium [90Y] microsphere injection. 2022 Drug Review Report. September 06, 2023. Regulatory documentation FGWJ-2023-10001
    PubMed
  • 76 Liu DM, Leung TW, Chow PK. et al. Clinical consensus statement: selective internal radiation therapy with yttrium 90 resin microspheres for hepatocellular carcinoma in Asia. Int J Surg 2022; 102: 106094
    CrossrefPubMedSearch in Google Scholar
  • 77 Chinese Medical Doctor Association, Clinical Guidelines Committee of Chinese College of Interventionalists, Chinese Research Hospital Association, Society for Hepato–pancreato–biliary Surgery. [Expert consensus on the standardized procedure of selective internal radiation therapy with yttrium-90 microspheres for liver malignancies (2024 edition)]. Zhonghua Yi Xue Za Zhi 2024; 104 (07) 486-498
    PubMedSearch in Google Scholar
  • 78 Peng ZW, Zhang YJ, Chen MS. et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol 2013; 31 (04) 426-432
    CrossrefPubMedSearch in Google Scholar
  • 79 Vitale A, Cabibbo G, Iavarone M. et al; HCC Special Interest Group of the Italian Association for the Study of the Liver. Personalised management of patients with hepatocellular carcinoma: a multiparametric therapeutic hierarchy concept. Lancet Oncol 2023; 24 (07) e312-e322
    CrossrefPubMedSearch in Google Scholar
  • 80 Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, Committee of Ablation Therapy in Oncology, Chinese Anti-Cancer Association.. Chinese expert consensus on co-ablation system for the treatment of primary liver cancer (2023 edition). J Intervent Radiol 2023; 32 (10) 949-953
    PubMedSearch in Google Scholar
  • 81 Luo J, Dong Z, Xie H. et al. Efficacy and safety of percutaneous cryoablation for elderly patients with small hepatocellular carcinoma: a prospective multicenter study. Liver Int 2022; 42 (04) 918-929
    CrossrefPubMedSearch in Google Scholar
  • 82 Wang C, Wang H, Yang W. et al. Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma. Hepatology 2015; 61 (05) 1579-1590
    CrossrefPubMedSearch in Google Scholar
  • 83 Liang SX, Zhu XD, Xu ZY. et al. Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Biol Phys 2006; 65 (02) 426-434
    CrossrefPubMedSearch in Google Scholar
  • 84 Wang W, Zeng Z. Chinese radiotherapy guidelines for primary hepatocellular carcinoma (2020 edition). J Clin Hepatol. 2021; 37 (05) 1029-1033
    PubMedSearch in Google Scholar
  • 85 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
    CrossrefPubMedSearch in Google Scholar
  • 86 Tao ZW, Cheng BQ, Zhou T, Gao YJ. Management of hepatocellular carcinoma patients with portal vein tumor thrombosis: a narrative review. Hepatobiliary Pancreat Dis Int 2022; 21 (02) 134-144
    CrossrefPubMedSearch in Google Scholar
  • 87 Yamakado K, Nakatsuka A, Tanaka N, Fujii A, Terada N, Takeda K. Malignant portal venous obstructions treated by stent placement: significant factors affecting patency. J Vasc Interv Radiol 2001; 12 (12) 1407-1415
    CrossrefPubMedSearch in Google Scholar
  • 88 Lu J, Zhong BY, Zhu HD, Guo JH, Teng GJ. Embolotherapy of unresectable hepatocellular carcinoma: Eastern perspective. Chin Clin Oncol 2019; 8 (06) 60-60
    CrossrefPubMedSearch in Google Scholar
  • 89 Park HC, Yu JI, Cheng JCH. et al. Consensus for radiotherapy in hepatocellular carcinoma from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): current practice and future clinical trials. Liver Cancer 2016; 5 (03) 162-174
    CrossrefPubMedSearch in Google Scholar
  • 90 Zhang ZH, Zhang W, Gu JY. et al. Treatment of hepatocellular carcinoma with tumor thrombus with the use of iodine-125 seed strand implantation and transarterial chemoembolization: a propensity-score analysis. J Vasc Interv Radiol 2018; 29 (08) 1085-1093
    CrossrefPubMedSearch in Google Scholar
  • 91 Lu J, Guo JH, Zhu HD, Zhu GY, Chen L, Teng GJ. Safety and efficacy of irradiation stent placement for malignant portal vein thrombus combined with transarterial chemoembolization for hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol 2017; 28 (06) 786-794.e3
    CrossrefPubMedSearch in Google Scholar
  • 92 Meng MB, Cui YL, Lu Y. et al. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol 2009; 92 (02) 184-194
    CrossrefPubMedSearch in Google Scholar
  • 93 Lu J, Guo JH, Ji JS. et al. Irradiation stent with 125 I plus TACE versus sorafenib plus TACE for hepatocellular carcinoma with major portal vein tumor thrombosis: a multicenter randomized trial. Int J Surg 2023; 109 (05) 1188-1198
    CrossrefPubMedSearch in Google Scholar
  • 94 Yang M, Fang Z, Yan Z. et al. Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial. J Cancer Res Clin Oncol 2014; 140 (02) 211-219
    CrossrefPubMedSearch in Google Scholar
  • 95 Luo JJ, Zhang ZH, Liu QX, Zhang W, Wang JH, Yan ZP. Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus. Hepatol Int 2016; 10 (01) 185-195
    CrossrefPubMedSearch in Google Scholar
  • 96 The Chinese Chapter of the International Hepato-Pancreato-Biliary Association, Group of Liver Surgery, Surgical Society of Chinese Medical Association, Expert Committee on Liver Cancer, Chinese Society of Clinical Oncology. Chinese multidisciplinary expert consensus on combined immunotherapy for hepatocellular carcinoma (2023 version). Zhonghua Xiaohua Waike Zazhi 2023; 22 (03) 293-315
    PubMedSearch in Google Scholar
  • 97 Finn RS, Qin S, Ikeda M. et al; IMbrave150 Investigators. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med 2020; 382 (20) 1894-1905
    CrossrefPubMedSearch in Google Scholar
  • 98 Qin S, Chen M, Cheng AL. et al; IMbrave050 Investigators. Atezolizumab plus bevacizumab versus active surveillance in patients with resected or ablated high-risk hepatocellular carcinoma (IMbrave050): a randomised, open-label, multicentre, phase 3 trial. Lancet 2023; 402 (10415): 1835-1847
    CrossrefPubMedSearch in Google Scholar
  • 99 Ren Z, Xu J, Bai Y. et al; ORIENT-32 Study Group. 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 (07) 977-990
    CrossrefPubMedSearch in Google Scholar
  • 100 Qin S, Chan SL, Gu S. et al; CARES-310 Study Group. Camrelizumab plus rivoceranib versus sorafenib as first-line therapy for unresectable hepatocellular carcinoma (CARES-310): a randomised, open-label, international phase 3 study. Lancet 2023; 402 (10408): 1133-1146
    CrossrefPubMedSearch in Google Scholar
  • 101 Xu J, Shen J, Gu S. et al. Camrelizumab in combination with apatinib in patients with advanced hepatocellular carcinoma (RESCUE): a nonrandomized, open-label, phase II trial. Clin Cancer Res 2021; 27 (04) 1003-1011
    CrossrefPubMedSearch in Google Scholar
  • 102 Abou-Alfa GK, Lau G, Kudo M. et al. Tremelimumab plus durvalumab in unresectable hepatocellular carcinoma. NEJM Evid 2022; 1 (08) a2100070
    PubMedSearch in Google Scholar
  • 103 Chan SL, Kudo M, Sangro B. et al. 83P Impact of viral aetiology in the phase III HIMALAYA study of tremelimumab (T) plus durvalumab (D) in unresectable hepatocellular carcinoma (uHCC). Ann Oncol 2022; 33: S1465-S1466
    CrossrefPubMedSearch in Google Scholar
  • 104 Chan SL, Kudo M, Sangro B. et al. 67O Outcomes in the Asian subgroup of the phase III HIMALAYA study of tremelimumab (T) plus durvalumab (D) in unresectable hepatocellular carcinoma (uHCC). Ann Oncol 2022; 33: S1456
    CrossrefPubMedSearch in Google Scholar
  • 105 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 (01) 25-34
    CrossrefPubMedSearch in Google Scholar
  • 106 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
    CrossrefPubMedSearch in Google Scholar
  • 107 Finn RS, Ikeda M, Zhu AX. et al. Phase Ib study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma. J Clin Oncol 2020; 38 (26) 2960-2970
    CrossrefPubMedSearch in Google Scholar
  • 108 Llovet JM, Kudo M, Merle P. et al; LEAP-002 Investigators. Lenvatinib plus pembrolizumab versus lenvatinib plus placebo for advanced hepatocellular carcinoma (LEAP-002): a randomised, double-blind, phase 3 trial. Lancet Oncol 2023; 24 (12) 1399-1410
    CrossrefPubMedSearch in Google Scholar
  • 109 Keam SJ, Duggan S. Donafenib: first approval. Drugs 2021; 81 (16) 1915-1920
    CrossrefPubMedSearch in Google Scholar
  • 110 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
    CrossrefPubMedSearch in Google Scholar
  • 111 Qin S, Kudo M, Meyer T. et al. Tislelizumab vs sorafenib as first-line treatment for unresectable hepatocellular carcinoma: a phase 3 randomized clinical trial. JAMA Oncol 2023; 9 (12) 1651-1659
    CrossrefPubMedSearch in Google Scholar
  • 112 Chinese Society of Clinical Oncology. Guidelines of Chinese Society of Clinical Oncology(CSCO): Immune Checkpoint Inhibitor Clinical Practice(2023 Edition). 1st ed.. People's Medical Publishing House; 2023
    Search in Google Scholar
  • 113 Bruix J, Qin S, Merle P. et al; RESORCE Investigators. 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
    CrossrefPubMedSearch in Google Scholar
  • 114 Li BK, Yuan Y, Qiao L. et al. 949P Regorafenib combined with immunotherapy versus regorafenib as second-line therapy in patients with advanced hepatocellular carcinoma: a multicenter real-world study. Ann Oncol 2023; 34: S596
    CrossrefPubMedSearch in Google Scholar
  • 115 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 (07) 559-568
    CrossrefPubMedSearch in Google Scholar
  • 116 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 (04) 571-580
    CrossrefPubMedSearch in Google Scholar
  • 117 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 (05) 500-509
    CrossrefPubMedSearch in Google Scholar
  • 118 Chen Q, Shu C, Laurence AD. et al. Effect of Huaier granule on recurrence after curative resection of HCC: a multicentre, randomised clinical trial. Gut 2018; 67 (11) 2006-2016
    CrossrefPubMedSearch in Google Scholar
  • 119 Zhai XF, Liu XL, Shen F, Fan J, Ling CQ. Traditional herbal medicine prevents postoperative recurrence of small hepatocellular carcinoma: a randomized controlled study. Cancer 2018; 124 (10) 2161-2168
    CrossrefPubMedSearch in Google Scholar
  • 120 Chang TT, Sawhney R, Monto A. et al. Implementation of a multidisciplinary treatment team for hepatocellular cancer at a Veterans Affairs Medical Center improves survival. HPB (Oxford) 2008; 10 (06) 405-411
    CrossrefPubMedSearch in Google Scholar