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1、Version 3 2019 08 01 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Hepatobiliary Cancers Versi
2、on 3 2019 August 1 2019 Continue NCCN org NCCN Guidelines Version 3 2019 Hepatobiliary Cancers Version 3 2019 08 01 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of
3、 NCCN NCCN Guidelines Index Table of Contents Discussion Al B Benson III MD Chair Robert H Lurie Comprehensive Cancer Center of Northwestern University Michael I D Angelica MD Vice Chair Memorial Sloan Kettering Cancer Center Daniel E Abbott MD University of Wisconsin Carbone Cancer Center Thomas A
4、Abrams MD Dana Farber Brigham and Women s Cancer Center Steven R Alberts MD MPH Mayo Clinic Cancer Center Daniel A Anaya MD Moffitt Cancer Center Robert Anders MD PhD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Chandrakanth Are MD Fred 141 36 44 or if AFP increases by 7 ng mL mont
5、h on at least 3 determinations Arrieta O Cacho B Morales Espinosa D et al The progressive elevation of alpha fetoprotein for the diagnosis of hepatocellular carcinoma in patients with liver cirrhosis BMC Cancer 2007 7 28 Positive AFP should prompt CT or MRI regardless of US results lUS negative mean
6、s no observation or only definitely benign observation s Patients at risk for HCC b Cirrhosisc Hepatitis B Cd Alcohol Genetic hemochromatosis Non alcoholic fatty liver disease NAFLD e Stage 4 primary biliary cholangitisf Alpha 1 antitrypsin deficiency Other causes of cirrhosisg Without cirrhosis Hep
7、atitis B carriersc h Additional workup See HCC 2 Repeat US AFP in 3 6 mo Version 3 2019 08 01 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines
8、Version 3 2019 Hepatocellular Carcinoma NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 8 5 2019 2 04 34 AM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved Note All recommendations are catego
9、ry 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged HCC 2 DIAGNOSIS OF HCCb FINDINGSIMAGINGaADDITIONAL WORKUP Positive imaging result Suspicious abnormality
10、 detected on imaging exam done for other reasons Positive AFP Abdominal multiphasic CT or MRI Observation s m detected No observationm detected Return to screening in 6 mo See HCC 1 Definitely HCCn Not definitely HCC not definitely benign Definitely benign HCC confirmed See HCC 3 Individualized work
11、up which may include additional imaginga or biopsy o p as informed by multidisciplinary discussion Return to screeningq in 6 mo See HCC 1 Version 3 2019 08 01 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any for
12、m without the express written permission of NCCN NCCN Guidelines Version 3 2019 Hepatocellular Carcinoma NCCN Guidelines Index Table of Contents Discussion aSee Principles of Imaging HCC A bAdapted with permission from Marrero JA Kulik LM Sirlin C et al Diagnosis staging and management of hepatocell
13、ular carcinoma 2018 practice guidance by the American Association for the Study of Liver Diseases Hepatology 2018 68 723 750 mAn observation is an area identified at imaging that is distinctive from background liver It may be a mass or a pseudo lesion nCriteria for observations that are definitely H
14、CC have been proposed by LI RADS and adopted by AASLD These criteria apply only to patients at high risk for HCC OPTN has proposed imaging criteria for HCC applicable in candidates for liver transplant See Principles of Imaging HCC A oBefore biopsy evaluate if patient is a resection or transplant ca
15、ndidate If patient is a potential transplant candidate consider referral to transplant center before biopsy pSee Principles of Biopsy HCC B qIf no observations are detected at diagnostic imaging despite positive surveillance tests then return to surveillance in 6 months if the most reasonable explan
16、ation is that surveillance tests were false positive Consider imaging with an alternative method AFP if there is reasonable suspicion that the diagnostic imaging test was false negative Printed by Maria Chen on 8 5 2019 2 04 34 AM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved Note All recommendations are category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient wi
