J.Jpn. Surg. Soc.. 109(6): 343-348, 2008

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Feature topic

COMPARISON OF THE CLINICAL PRACTICE GUIDELINES FOR HEPATOCELLULAR CARCINOMA IN JAPAN AND WESTERN COUNTRIES

Patients with hepatitis B/C infection or liver cirrhosis are at high risk of developing hepatocellular carcinoma (HCC). The establishment of surveillance and treatment strategies is therefore important to improve their prognosis. The 2005 Japanese "Clinical Practice Guidelines for Hepatocellular Carcinoma" and 2005 US "AASLD Practice Guidelines: Management of Hepatocellular Carcinoma" both proposed that surveillance should be performed using ultrasonography, and that HCC could be definitively diagnosed based on typical imaging findings detected using dynamic computed tomography or magnetic resonance imaging. However, there are differences between Japan and the West in the consensus on tumor marker measurements in surveillance and diagnostic algorithms for nodules without typical image findings. In the treatment algorithm, the most important difference is the role of liver transplantation. Living-donor liver transplantation is preferred in Japan, while cadaveric liver transplantation is preferred in the USA, and therefore hepatic resection and local ablation therapy also have different roles in curative treatment. Several social factors, such as the widespread use of new diagnostic instruments and therapeutic modalities and difficulties in securing liver donors, have resulted in differences in the clinical practice guidelines between Japan and the West.

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