Clinical practice guideline and real-life practice in hepatocellular carcinoma: Chinese perspective

Liver cancer ranks the fourth most prevalent and the second most lethal cancer in China. Hepatitis B virus (HBV) infection represents the major risk factor for hepatocellular carcinoma(HCC) in China. Liver US plus AFP every 6 months continues to be the predominant surveillance modality. The aMAP score is newly recommended in the 2022 Chinese guidelines to predict HCC occurrence. China liver cancer (CNLC) staging system proposed in the 2017 guideline continues to be the standard model for staging with modifications in the treatment allocations. Considering the aggressive nature of HBV-associated HCC, multi-modal and high-intensity strategies treatments like the addition of immunotherapy-based systemic treatment to local therapies including resection, ablation, intra-arterial therapies have been adopted in real-life practices in China. The latest Chinese guidelines recommend atezolizumab plus bevacizumab, suntilimab plus bevacizumab analogue, lenvatinib, sorafenib, donafenib and FOLFOX chemotherapy as the first-line treatment without priority. Apart from regorafenib, apatinib, camrelizumab and tislelizumab are newly added as the second-line systemic therapies for patients who progressed on sorafenib. Systemic therapies adopted in real life practice are sophisticated with various combination modality and different sequences.