Journal Article Ahead of print
PubMed: 40755008 DOI: 10.3350/cmh.2025.0724
Taiwan Liver Cancer Association Management Consensus Guidelines for Intermediate Stage Hepatocellular Carcinoma.
Clin Mol Hepatol
Authors: I-Cheng Lee, Hung-Wei Wang, Wei Teng, Tsung-Jung Lin, Chien-Hung Chen, Hsueh-Chou Lai, Teng-Yu Lee, Ching-Wei Chang, Chao-Hung Hung, Chia-Yen Dai, Yi-Ping Hung, Ying-Chun Shen, Chien-Wei Su, Ming-Chih Ho, Wei-Chen Lee, Gar-Yang Chau, Chin-Tsung Ting, Po-Chin Liang, Chien-An Liu, Pi-Yi Chang, Kuan-Yang Chen, Shi-Ming Lin, Li-Tzong Chen, Yi-Hsiang Huang
Affiliations
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
- School of Medicine, China Medical University, Taichung, Taiwan.
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- Hepato-Biliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Quality Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- Department of Medical Oncology, National Taiwan University Cancer Center, Taiwan.
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taiwan.
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
- Departments of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan.
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan, ROC.
- Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
- Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
- Department of Medical Imaging, Taichung Veterans General Hospital.
- Department of Post-Baccalaureate Medicine, National Chung Hsing University.
- Kaohsiung Medical University Hospital, Center for Cancer Research, Kaohsiung Medical University, Kaohsiung.
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Abstract
Intermediate-stage hepatocellular carcinoma (HCC) encompasses a diverse patient population that requires individualized treatment strategies and a multidisciplinary approach. Recent advancements in systemic therapy have expanded the therapeutic options for intermediate-stage HCC, allowing for combination strategies such as systemic therapy with transarterial chemoembolization (TACE) and upfront systemic therapy for individuals deemed unsuitable for TACE. Additionally, the ongoing development of treatment modalities for intermediate-stage HCC has improved the potential for curative conversion and tumor downstaging. Nevertheless, consensus on the optimal management of intermediate-stage HCC remains limited. Thus, the primary aim of this study was to develop a set of consensus guidelines for the management of intermediate-stage HCC. To address this gap, the Taiwan Liver Cancer Association (TLCA) established a working group to develop a multidisciplinary strategy for managing intermediate-stage HCC. Here, we present eight consensus statements formulated by this expert panel, which outline criteria for TACE unsuitability, treatment recommendations based on TACE eligibility, and considerations for various modalities, including conventional TACE, drug-eluting bead TACE, and transarterial radioembolization, as well as the appropriate timing for initiating systemic therapy to enable curative conversion and downstaging. These statements provide specific, evidence-based recommendations for clinicians, addressing treatment pathways based on TACE eligibility and other key considerations for intermediate-stage HCC management. The development of this consensus guideline is intended to aid clinicians in selecting the most appropriate treatment pathway for intermediate-stage HCC, support personalized treatment planning, and ultimately enhance the feasibility of achieving curative conversion.
MeSH
Liver Diseases, Carcinoma, Hepatocellular, Neoplasms, Liver, Immunotherapy, Liver Neoplasms, Therapeutics