Interpretation of NCCN clinical practice guidelines for hepatocellular carcinoma, version 2.2023

Abstract

Abstract:

The National Comprehensive Cancer Network (NCCN), as the world's leading non-profit consortium in the field of oncology, continues to update clinical practice guidelines for multiple malignancies annually and has become a benchmark for clinical practice guidelines in oncology worldwide. Currently, the NCCN clinical practice guidelines for hepatocellular carcinoma have been updated to version 2.2023, as compared with version 1.2023 of its main updates for the content of the discussion section. The NCCN guidelines for hepatobiliary cancers have been reorganized to separate guidelines for biliary tract cancers and hepatocellular carcinoma since version 1.2023. The main updates focus on tumor screening, diagnosis, surgery, adjuvant therapy, locoregional therapy, systemic therapy, and so on. The molecular testing was added for the first time. Therefore, the updates of version 1.2023 were highlighted again in the new version 2.2023. This article interpreted the new guidelines and focused on the aspects of updates.

Key words:Hepatocellular carcinoma,National Comprehensive Cancer Network(NCCN),Guidelines,Update

CLC Number:

R735.7

SHI Chunchao, WANG Kui. Interpretation of NCCN clinical practice guidelines for hepatocellular carcinoma, version 2.2023[J]. Journal of Surgery Concepts & Practice, 2024, 29(02): 99-105.

Figures/Tables1

Tab 1

Updated principle of systemic treatment

一线系统治疗
优先推荐方案	其他推荐方案	特定情况下有用方案
阿替利珠单抗+贝伐珠单抗（仅适用于肝功能Child-Pugh A级；1类证据）；替西木单抗（tremelimumab）+度伐利尤单抗（1类证据）。	索拉非尼[肝功能为Child-Pugh A级（1类证据）或B7级]；仑伐替尼（lenvatinib）（仅适用于肝功能Child-Pugh A级，1类证据）；度伐利尤单抗（1类证据）；帕博利珠单抗（2B类证据）。	纳武利尤单抗（仅适用于肝功能Child-Pugh B级）；阿替利珠单抗+贝伐珠单抗（仅适用于肝功能Child-Pugh B级）；纳武利尤单抗+伊匹木单抗（适用于TMB-H肿瘤，2B类证据）。
二线系统治疗
可选方案	其他推荐方案	特定情况下有用方案
瑞戈非尼（regorafenib）（仅适用于肝功能Child- Pugh A级，1类证据）；卡波替尼（cabozantinib)（仅适用于肝功能Child- Pugh A级，1类证据）；仑伐替尼（仅适用于肝功能Child-Pugh A级）；索拉非尼（sorafenib)（肝功能Child-Pugh A级或B7级）。	纳武利尤单抗+伊匹木单抗（仅适用于肝功能Child-Pugh A级）；帕博利珠单抗（仅适用于肝功能Child-Pugh A级）。	雷莫芦单抗（仅适用于AFP≥400 μg/L且肝功能Child-Pugh A级，1类证据）；纳武利尤单抗（适用于肝功能Child-Pugh B级）；多塔利单抗（dostarlimab）（适用于MSI-H/错配修复缺陷(deficiency mismatch repair, dMMR)肿瘤，2B类证据）；塞尔帕替尼（selpercatinib）（适用于RET转染重排基因融合阳性肿瘤，2B类证据）；纳武利尤单抗+伊匹木单抗（适用于TMB-H肿瘤，标准疗法难治性疾病或没有可用标准治疗方案者，2B类证据）。

Tab 1

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