EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma European Association for the Study of the Liver⇑, European Organisation for Research and Treatment of Cancer Introduction EASL–EORTC Clinical Practice Guidelines (CPG) on the management of hepatocellular carcinoma (HCC) deﬁne the use of surveillance, diagnosis, and therapeutic strategies recommended for patients with this type of cancer. This is the ﬁrst European joint effort by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) to provide common guidelines for the management of hepatocellular carcinoma. These guidelines update the recommendations reported by the EASL panel of experts in HCC published in 2001 . Several clinical and scientiﬁc advances have occurred during the past decade and, thus, a modern version of the document is urgently needed. The purpose of this document is to assist physicians, patients, health-care providers, and health-policy makers from Europe and worldwide in the decision-making process according to evidencebased data. Users of these guidelines should be aware that the recommendations are intended to guide clinical practice in circumstances where all possible resources and therapies are available. Thus, they should adapt the recommendations to their local regulations and/or team capacities, infrastructure, and cost– beneﬁt strategies. Finally, this document sets out some recommendations that should be instrumental in advancing the research and knowledge of this disease and ultimately contribute to improve patient care. The EASL–EORTC CPG on the management of hepatocellular carcinoma provide recommendations based on the level of eviReceived 15 December 2011; accepted 15 December 2011 Contributors: Chairmen: Josep M. Llovet (EASL); Michel Ducreux (EORTC). Clinical Practice Guidelines Members: Riccardo Lencioni; Adrian M. Di Bisceglie; Peter R. Galle; Jean Francois Dufour; Tim F. Greten; Eric Raymond; Tania Roskams; Thierry De Baere; Michel Ducreux; and Vincenzo Mazzaferro. EASL Governing Board Representatives: Mauro Bernardi. Reviewers: Jordi Bruix; Massimo Colombo; Andrew Zhu. ⇑ Correspondence: EASL Ofﬁce, 7 rue des Battoirs, CH-1205 Geneva, Switzerland. Tel.: +41 22 807 0360; fax: +41 22 328 0724. E-mail address: easlofﬁce@easlofﬁce.eu ( European Association for the Study of the Liver). Abbreviations: HCV, Hepatitis C virus; SNP, Single nucleotide polymorphism; PEG, Polyethylene glycol; HALT-C, Hepatitis C antiviral long-term treatment against cirrhosis; EPIC, Evaluation of PegIntron in control of hepatitis C cirrhosis; CT, Computed tomography; MR, Magnetic resonance; MRI, Magnetic resonance imaging; EpCAM, Epithelial cell adhesion molecule; PPV, Positive predictive value; qRT-PCR, Real-time reverse-transcription polymerase chain reaction; CUPI, Chinese university prognostic index; CLIP, Cancer of the Liver Italian program; SHARP, Sorafenib hepatocellular carcinoma assessment randomised protocol. These Guidelines were developed by the EASL and the EORTC and are published simultaneously in the Journal of Hepatology (volume 56, issue 4) and the European Journal of Cancer (volume 48, issue 5).
dence and the strength of the data (the classiﬁcation of evidence is adapted from National Cancer Institute ) (Table 1A) and the strength of recommendations following previously reported systems (GRADE systems) (Table 1B).
Clinical Practice Summary The clinical practice guidelines below will give advice for up to date management of patients with HCC as well as providing an in-depth review of all the relevant data leading to the conclusions.
Clinical Practice Summary
• Patients at high risk for developing HCC should be entered into surveillance programs. Groups at high risk are depicted in Table 3 (evidence 1B/3A; recommendation 1A/B) Surveillance should be performed by experienced...