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      Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

      guideline
      a , a , a , b , c , d , e , f , g , h , i , j , k , l , a , m , n , o , p , q , r , s , t , u , v , w , x , y , z , A , B , C , D , E , F , a , G , H , I , J , a , K , a , L , e , M , c , a , a , a , N , O , P , Q , R , e , S , a , *
      Liver Cancer
      S. Karger AG
      Cancer, Carcinoma, China, Liver, Diagnosis, Treatment

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background: Hepatocellular carcinoma (HCC) (about 85–90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people. Summary: This guideline presents official recommendations of the National Health and Family Planning Commission of the People’s Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations. Key Messages: The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

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          Most cited references100

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          From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors.

          The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments.
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            Randomized controlled trial of screening for hepatocellular carcinoma.

            Screening for hepatocellular carcinoma (HCC) has been conducted for over 20 years, but there is no conclusive evidence that screening may reduce HCC mortality. The aim of this study was to assess the effect of screening on HCC mortality in people at increased risk. This study included 18,816 people, aged 35-59 years with hepatitis B virus infection or a history of chronic hepatitis in urban Shanghai, China. Participants were randomly allocated to a screening (9,373) or control (9,443) group. Controls received no screening and continued to use health-care facilities. Screening group participants were invited to have an AFP test and ultrasonography examination every 6 months. Screening was stopped in December 1997; by that time screening group participants had been offered five to ten times. All participants were followed up until December 1998. The primary outcome measure was HCC mortality. The screened group completed 58.2 percent of the screening offered. When the screening group was compared to the control group, the number of HCC was 86 versus 67; subclinical HCC being 52 (60.5%) versus 0; small HCC 39 (45.3%) versus 0; resection achieved 40 (46.5%) versus 5 (7.5%); 1-, 3,-, and 5-year survival rate 65.9%, 52.6%, 46.4% versus 31.2%, 7.2%, 0, respectively. Thirty-two people died from HCC in the screened group versus 54 in the control group, and the HCC mortality rate was significantly lower in the screened group than in controls, being 83.2/100,000 and 131.5/100,000, respectively, with a mortality rate ratio of 0.63 (95%CI 0.41-0.98). Our finding indicated that biannual screening reduced HCC mortality by 37%.
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              FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0

              The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the physician and physicist to assist to carrying out, interpret, and document quantitative FDG PET/CT examinations, but will concentrate on the optimisation of diagnostic quality and quantitative information.
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                Author and article information

                Journal
                LIC
                LIC
                10.1159/issn.1664-5553
                Liver Cancer
                S. Karger AG
                2235-1795
                1664-5553
                2018
                September 2018
                14 June 2018
                : 7
                : 3
                : 235-260
                Affiliations
                [_a] aDepartment of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, China
                [_A] ADepartment of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
                [_b] bDepartment of Pathology, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
                [_B] BDepartment of General Surgery, the First Hospital of Jilin University, Jilin, China
                [_c] cDepartment of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
                [_C] CDepartment of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
                [_d] dDepartment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
                [_D] DDepartment of Interventional Radiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
                [_e] eDepartment of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
                [_E] EDepartment of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
                [_f] fInstitute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
                [_F] FDepartment of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
                [_g] gDepartment of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
                [_G] GDepartment of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, China
                [_h] hDepartment of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
                [_H] HDepartment of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China
                [_i] iDepartment of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
                [_I] IDepartment of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                [_j] jDepartment of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
                [_J] JDepartment of Hepatic Surgery and Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
                [_k] kDepartment of Interventional Radiology, the Tumor Hospital of Harbin Medical University, Harbin, China
                [_K] KDepartment of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China
                [_l] lDepartment of Interventional Oncology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
                [_L] LDepartment of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
                [_m] mDepartment of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
                [_M] MDepartment of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing, China
                [_n] nDepartment of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
                [_N] NDepartment of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
                [_o] oDepartment of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
                [_O] ODepartment of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
                [_p] pDepartment of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
                [_P] PDepartment of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
                [_q] qEditorial Department of Chinese Journal of Digestive Surgery, Chongqing, China
                [_Q] QDepartment of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital (BTCH), School of Clinical Medicine, Tsinghua University, Beijing, China
                [_r] rDepartment of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
                [_R] RDepartment of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
                [_s] sDepartment of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
                [_S] SDepartment of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China
                [_t] tDepartment of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
                [_u] uDepartment of integrated treatment, Tumor Hospital of Fudan University, Shanghai, China
                [_v] vDepartment of Hepatobiliary and Spleenary Surgery, the Affiliated Shengjing Hospital, China Medical University, Shenyang, China
                [_w] wDepartment of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, China
                [_x] xDepartment of Nuclear Medicine, the First Hospital of China Medical University, Shenyang, China
                [_y] yDepartment of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
                [_z] zDepartment of Oncology, Peking University International Hospital, Beijing, China
                Author notes
                *Dr. Jia Fan, Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032 (China), E-Mail fan.jia@zs-hospital.sh.cn, Dr. Shu-Kui Qin, Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing 210002 (China), E-Mail qinsk@csco.org.cn
                Article
                488035 PMC6167671 Liver Cancer 2018;7:235–260
                10.1159/000488035
                PMC6167671
                30319983
                68cdb201-0aab-4b84-a296-63f2e548476f
                © 2018 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 03 January 2018
                : 24 February 2018
                Page count
                Figures: 2, Pages: 26
                Categories
                Consensus Statement

                Oncology & Radiotherapy,Gastroenterology & Hepatology,Surgery,Nutrition & Dietetics,Internal medicine
                China,Carcinoma,Diagnosis,Cancer,Liver,Treatment

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