BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA

CHAGAS, Aline Lopes; MATTOS, Angelo Alves de; CARRILHO, Flair José; BITTENCOURT, Paulo Lisboa; ,

doi:10.1590/S0004-2803.202000000-20

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ORIGINAL ARTICLE • Arq. Gastroenterol. 57 (suppl 1) • 2020 • https://doi.org/10.1590/S0004-2803.202000000-20 copy

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA

Atualização das recomendações da Sociedade Brasileira de Hepatologia para o diagnóstico e tratamento do carcinoma hepatocellular

Authorship Authorship About the non-byline-authors SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

HEADINGS:
Hepatocelullar carcinoma, diagnosis; Hepatocelullar carcinoma, therapy; Liver neoplasms; Medical societies; Brazil

Level of Evidence		Degree of confidence in the evidence
High	Data from meta-analyzes or systematic reviews or various high quality randomized controlled trials.	Future research is unlikely to change the proposal presented.
Moderate	Data from a single randomized controlled trial or from multiple nonrandomized studies.	Future research may have impact on the proposal presented.
Low	Data from small studies, retrospective, observational studies or case series	Future research is likely to have a significant impact on the proposal presented.
Grade of Recommendation		Writing associated with degree of recommendation
Strong		“must”, “strongly indicated” or “SBH recommends”
Weak		“can” or “SBH suggests”

Nodule	Histological features
Regenerative macrodule	A nodule larger than adjacent cirrhotic nodules, but histologically similar to them.
Low-grade Dysplastic Nodule (LGDN)	Nodule whose cells look similar to mature hepatocytes with minor architectural or cytological atypia.
High-grade Dysplastic Nodule (HGDN)	Presence of more severe cellular or architectural atypia (“cell crowding”), but not enough for the diagnosis of HCC.
Small HCC (less than 2 cm)	Early HCC: nodular type with indistinct margins, with cells presenting minor atypia and foci of stromal invasion. Progressive HCC: nodular type. Cells may presente mild or moderate atypia

Relative contraindications
Tumor burden > 50% of total liver volume or large tumors (> 10 cm)
Biliary-enteric anastomosis or biliary stent
Severe comorbidities
Bile duct dilation
Iodine Contrast Allergy*
Untreated esophageal varices at high risk of bleeding
Absolute contraindications
Decompensated cirrhosis: jaundice, encephalopathy, ascites and/or hepatorenal syndrome
Child-Pugh ≥ B8
Macrovascular tumor invasion of the portal vein trunk or main portal branches
Reduction of portal vein blood flow (portal vein thrombosis or hepatofugal flow)
Technical contraindications to hepatic intraarterial treatment (e.g., intractable arteriovenous fistula)
Renal impairment (creatinine ≥2 mg/dL or creatinine clearance ≤ 30 mL/min)

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] Corresponding author: Aline Lopes Chagas, MD. E-mail: alinelchagas@gmail.com

0	Fully active, able to carry on all pre-disease performance without restriction
1	Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2	Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours
3	Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours
4	Completely disabled; cannot carry on any selfcare; totally confined to bed or chair
5	Dead