Hepatocellular carcinoma — guideline registry¶
Last checked: 2026-08-30
This registry catalogs guideline documents; recommendation synthesis is in wiki/guidelines.md. PubMed identifiers were retrieved live in this build session. “Current” means the latest document found for that body and scope, not a guarantee that every recommendation reflects publications after its search cutoff.
Master table¶
| Body | Year | Region | Scope | Citation | Status |
|---|---|---|---|---|---|
| AASLD | 2023 | United States | Prevention, surveillance, diagnosis, staging, treatment | Singal et al. Hepatology. PMID 37199193 | current |
| EASL | 2025 | Europe/international | Full HCC management | EASL. J Hepatol. PMID 39690085 | current; supersedes EASL 2018 |
| ESMO | 2025 | Europe/international oncology | Diagnosis, treatment, follow-up | Vogel et al. Ann Oncol. PMID 39986353 | current; supersedes ESMO 2018/eUpdates |
| BCLC | 2022 | International strategy | Prognosis and treatment allocation | Reig et al. J Hepatol. PMID 34801630 | current strategy update |
| APASL | 2017 | Asia-Pacific | Full HCC management | Omata et al. Hepatol Int. PMID 28620797 | current document retrieved; watch for update |
| APASL | 2024 | Asia-Pacific | Systemic therapy focused update | Lau et al. Hepatol Int. PMID 39570557 | current for systemic therapy; overlays APASL 2017 |
| Japan Society of Hepatology | 2021 | Japan | Prevention through systemic therapy | Kudo et al. Liver Cancer. PMID 34239808 | current consensus retrieved |
| KLCA-NCC Korea | 2022 | Korea | Full HCC management | KLCA-NCC. Clin Mol Hepatol. PMID 36263666 | current |
| Chinese guideline | 2024 | China | Full HCC management | Zhou et al. Liver Cancer. PMID 41063733 | current; supersedes 2022 edition |
| Chinese guideline | 2022 | China | Full HCC management | Review of guideline: Xie et al. PMID 37124695 | superseded by → China 2024 (PMID 41063733) |
| KLCA-NCC Korea | 2022/2023 | Korea | Imaging-focused implementation update | Joo et al. Korean J Radiol. PMID 36606612 | current component commentary |
| KLCA-NCC Korea | 2022/2023 | Korea | Local-ablation implementation update | Lee et al. Korean J Radiol. PMID 36606614 | current component commentary |
| KLCA-NCC Korea | 2022/2023 | Korea | Transarterial-therapy implementation update | Lee et al. Korean J Radiol. PMID 36606613 | current component commentary |
| OPTN | 2023 | United States transplant allocation | HCC imaging classification and LI-RADS alignment | Kierans et al. Liver Transpl. PMID 36097856 | current analysis of allocation framework |
| EASL | 2018 | Europe | Full HCC management | EASL. J Hepatol. PMID 29628281 | superseded by → EASL 2025 (PMID 39690085) |
AASLD 2023¶
Citation: Singal AG, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78:1922-1965. PMID 37199193.
Key contribution: Integrates risk-based surveillance, ultrasound plus AFP, LI-RADS diagnosis, BCLC-linked treatment, transplantation/downstaging, radiation, and immunotherapy-era systemic treatment for US practice.
Evidence boundary: Published before CheckMate 9DW's indexed 2026 subgroup publication and before 2025 EMERALD-1/LEAP-012 phase 3 publications. Systemic and intermediate-stage combination sections therefore need active update surveillance.
Status: Current AASLD HCC practice guidance retrieved.
EASL 2025¶
Citation: European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol. 2025;82:315-374. PMID 39690085.
Key contribution: Updates European recommendations across personalized surveillance, imaging diagnosis, multiparametric allocation, surgical/locoregional options, combination immunotherapy, and transitions between treatment stages.
Supersession: EASL 2018 (PMID 29628281) → EASL 2025 (PMID 39690085).
Evidence boundary: Publication timing overlaps rapidly evolving first-line dual-IO, adjuvant follow-up, and TACE-combination evidence; verify online corrections and formal updates.
Status: Current.
ESMO 2025¶
Citation: Vogel A, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2025;36:491-506. PMID 39986353.
Key contribution: Current oncology-focused European guidance spanning diagnosis, stage-linked treatment, locoregional and systemic therapy, follow-up, and multidisciplinary care.
Supersession: ESMO 2018 (PMID 30285213) and subsequent eUpdates (PMID 31168599) → ESMO 2025 (PMID 39986353).
Evidence boundary: Search and publication timing precede the 2026 IMbrave050 update and some post-immunotherapy sequencing reports; recommendation currency should be assessed by domain rather than publication year alone.
Status: Current.
BCLC 2022 strategy¶
Citation: Reig M, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76:681-693. PMID 34801630.
Key contribution: Subdivides BCLC B, formalizes stage migration and untreatable progression, and links prognosis with a flexible treatment strategy.
Registry note: BCLC is a strategy/staging framework rather than a society guideline, but it is included because AASLD/EASL treatment allocation depends on it.
Status: Current retrieved update; systemic agent details require overlay with later guidelines.
APASL 2017¶
Citation: Omata M, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11:317-370. PMID 28620797.
Key contribution: Asia-Pacific risk populations, surveillance, regional imaging practice, surgery, ablation, transarterial therapy, and systemic management.
Evidence boundary: Predates IMbrave150, HIMALAYA, CheckMate 9DW, and modern TACE-systemic phase 3 combinations. It remains valuable for regional diagnostic and curative-treatment framing but is outdated for systemic sequencing.
Status: Current APASL document retrieved in this session; high-priority watch item.
APASL systemic therapy 2024¶
Citation: Lau G, et al. APASL clinical practice guidelines on systemic therapy for hepatocellular carcinoma—2024. Hepatol Int. 2024;18:1661-1683. PMID 39570557.
Key contribution: Updates the systemic domain for first-line immunotherapy combinations, kinase inhibitors, later-line therapy, and Asia-Pacific agents/approvals without replacing every surveillance, imaging, surgical, or transplant section of APASL 2017.
Evidence boundary: Regional approvals and China/Asia-dominant trial populations affect transportability; it predates some 2025–2026 survival and sequencing reports.
Status: Current focused update; use together with, not as a full supersession of, APASL 2017.
Japan Society of Hepatology 2021¶
Citation: Kudo M, et al. Management of hepatocellular carcinoma in Japan: JSH consensus statements and recommendations 2021 update. Liver Cancer. 2021;10:181-223. PMID 34239808.
Key contribution: Japan-specific surveillance, diagnostic imaging, ablation, surgery, transarterial therapy, hepatic arterial infusion, and systemic treatment.
Evidence boundary: Regional technology, drug access, and treatment intensity differ from Western algorithms. Published before several first-line and combination readouts.
Status: Current retrieved consensus update.
KLCA-NCC Korea 2022¶
Citation: Korean Liver Cancer Association and National Cancer Center Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol. 2022;28:583-705. PMID 36263666.
Key contribution: Detailed Korean recommendations for surveillance, imaging, local ablation, transarterial therapy, surgery, radiation, and systemic treatment.
Evidence boundary: HBV-predominant regional epidemiology and technology access affect transportability. Later phase 3 IO/TACE evidence is not fully incorporated.
Status: Current.
China 2024¶
Citation: Zhou J, et al. China Liver Cancer Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2024 Edition). Liver Cancer. 2025;14:779-835. PMID 41063733.
Key contribution: Current indexed primary guideline covering Chinese staging, surgery, ablation, transarterial therapy, radiotherapy, hepatic arterial infusion, systemic therapy, and multimodality care.
Evidence boundary: National availability, expertise, HBV-predominant epidemiology, and use of HAIC and regionally approved agents differ from many Western systems.
Supersession: China 2022 (represented by PMID 37124695) → China 2024 (PMID 41063733).
Status: Current.
China 2022 — superseded¶
Indexed source used: Xie DY, et al. A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights. PMID 37124695.
Key contribution: Summarizes Chinese staging and treatment recommendations, including surgery, locoregional modalities, systemic agents, and combinations used in China.
Evidence boundary: The PubMed source retrieved is a review of the Chinese guideline rather than the primary guideline record. Confirm the official Chinese-language document before using exact recommendation class/grade.
Status: Superseded by China 2024 (PMID 41063733); retained for version history.
Korea 2022 component updates¶
The full KLCA-NCC document is supplemented by indexed implementation summaries for imaging diagnosis (Joo 2023, PMID 36606612), local ablation (Lee 2023, PMID 36606614), and transarterial therapy (Lee 2023, PMID 36606613). These clarify modality-specific changes and should not be counted as three independent guideline families.
OPTN allocation framework¶
Citation: Kierans AS, et al. The Organ Procurement and Transplantation Network hepatocellular carcinoma classification: alignment with Liver Imaging Reporting and Data System, current gaps, and future direction. Liver Transpl. 2023;29:206-216. PMID 36097856.
Key contribution: Explains why an allocation classification prioritizes specificity, reproducibility, and national auditability and therefore cannot automatically adopt every diagnostic LI-RADS refinement.
Status: Current framework analysis; exact OPTN policy text and effective dates should be checked directly before allocation decisions.
Disagreements and gaps¶
| Topic | Divergence | Why unresolved |
|---|---|---|
| AFP in surveillance | Inclusion, threshold, and longitudinal use vary | Sensitivity gain versus false positives |
| Non-cirrhotic HBV surveillance | Demographic and risk-score thresholds differ | Regional incidence and cost-effectiveness |
| Advanced fibrosis/MASLD | Routine versus individualized/no surveillance | Low absolute incidence and weak trial evidence |
| CEUS diagnosis | First-line, second-line, or limited role | Contrast, expertise, and false-positive concern |
| Resection with portal hypertension | Relative versus near-absolute constraint | Selection bias and surgical expertise |
| Multifocal/vascular-invasive surgery | More expansive in some Asian algorithms | Few randomized comparisons |
| Transplant expansion | Milan, AFP models, downstaging entry limits | Scarcity, donor system, recurrence tolerance |
| BCLC B | TACE, TARE, HAIC, radiation, or systemic migration | Heterogeneous disease and fast-changing evidence |
| First-line systemic therapy | Multiple unranked IO combinations | No head-to-head trials |
| Child-Pugh B | Conditional treatment varies | Pivotal RCT exclusion |
Supersession chains¶
- EASL 2018 (PMID 29628281) → EASL 2025 (PMID 39690085).
- ESMO 2018 (PMID 30285213) and eUpdates (PMID 31168599) → ESMO 2025 (PMID 39986353).
- BCLC earlier iterations → BCLC 2022 (PMID 34801630); earlier documents are historical and not separately catalogued here.
- KLCA-NCC earlier editions → KLCA-NCC 2022 (PMID 36263666).
- JSH earlier consensus editions → JSH 2021 (PMID 34239808).
- China 2022 (PMID 37124695) → China 2024 (PMID 41063733).
- APASL 2017 full guideline (PMID 28620797) + APASL 2024 systemic overlay (PMID 39570557); this is a scope overlay, not full-document supersession.
Watch list¶
- APASL full guideline update incorporating contemporary IO combinations.
- AASLD update incorporating CheckMate 9DW, EMERALD-1, LEAP-012, and mature IMbrave050 follow-up.
- EASL/ESMO corrections or focused position papers after 2025.
- China guideline corrections or implementation documents after the indexed 2024 edition.
- Transplant-society guidance on checkpoint exposure before/after liver transplant.
- Formal guidance on abbreviated MRI and blood-panel surveillance.
- Child-Pugh B systemic-treatment recommendations based on prospective data.
Retrieval notes¶
Live PubMed E-utilities searches were refreshed on 2026-08-30 as part of the audit. The refresh recovered the exact current ESMO HCC guideline (PMID 39986353), correcting the prior false-negative search, and reverified the APASL 2024 systemic guideline, indexed primary China 2024 guideline, Korean modality-specific summaries, and OPTN/LI-RADS alignment paper.