1. Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma
- Author
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Federico Piñero, Mario Tanno, Gabriel Aballay Soteras, Matías Tisi Baña, Melisa Dirchwolf, Eduardo Fassio, Andrés Ruf, Silvia Mengarelli, Silvia Borzi, Nora Fernández, Ezequiel Ridruejo, Valeria Descalzi, Margarita Anders, Guillermo Mazzolini, Virginia Reggiardo, Sebastián Marciano, Florencia Perazzo, Juan Carlos Spina, Lucas McCormack, Martín Maraschio, Cecilia Lagues, Adrián Gadano, Federico Villamil, Marcelo Silva, Fernando Cairo, and Beatriz Ameigeiras
- Subjects
Liver cancer ,Practice guideline ,Latin America ,Argentina ,Specialties of internal medicine ,RC581-951 - Abstract
The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline.
- Published
- 2020
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