1. HCC Guidelines 2011 1

2. NCCN guidelines Clinical presentation Treatment Surveillance
Imaging every 3–6 months for 2 years, then annually
AFP, if initially elevated, every 3 months for 2 years, then every 6 months
Transplant candidate
Evaluate whether patient is a candidate for transplant (See UNOS criteria under Surgical Assessment HCC-4)b
Transplant
Inadequate hepatic reserve
Tumor location
Options:
Sorafenib (Child–Pugh Class A [category 1] or B)
Chemotherapy + RT only in the context of a clinical trial
Clinical trial
Locoregional therapy
RT (conformal or stereotactic) (category 2B)
Supportive care
Systemic or intra-arterial chemotherapy in clinical trial
Not a transplant candidate
Unresectable
Extensive liver disease
Options:
Sorafenib (Child–Pugh Class A [category 1] or B)
Clinical trial
Locoregional therapy
RT (conformal or stereotactic) (category 2B)
Supportive care
Inoperable by perfomance status or comorbidity, local disease only
Sorafenib (Child–Pugh Class A [category 1] or B)
Supportive care
Clinical trial
Metastatic disease
NCCN Clinical Practice Guidelines in Oncology. Hepatobiliary Cancer. V2.2010; Available from:

3. Sorafenib or systemic therapy trial Resection/RFA (for < 3 cm HCC)
APASL guidelines
HCC
Confined to the liver
Main portal vein patent
Extrahepatic metastasis
Main portal vein tumor thrombus
Resectable
Child–Pugh A/B
Child–Pugh C
Sorafenib or systemic therapy trial
Yes No
Solitary tumor < 5 cm < 3 tumors < 3 cm
No venous invasion
Tumor > 5 cm > 3 tumors
Invasion of hepatic / portal vein branches
Resection/RFA (for < 3 cm HCC)
Child–Pugh A
Child–Pugh B
Child–Pugh C
Child–Pugh A/B
Child–Pugh C
Local ablation
Transplantation
TACE
Supportive care
APASL recommendations on HCC, Omata M, et al. Hepatol Int. 2010;4:439–474

4. AASLD guidelines HCC Portal pressure/ bilirubin PEI/RFA Sorafenib
Stage 0 PST 0, Child–Pugh A
Very early stage (0)
1 HCC < 2 cm Carcinoma in situ
Early stage (A)
1 HCC or 3 nodules < 3 cm, PST 0
End stage (D)
Liver transplantation
TACE
Resection
Symptomatic treatment (20%)
Survival < 3 months
Curative treatments (30%)
5-year survival (40–70%)
Palliative treatments (50%)
Median survival 11–20 months
Associated diseases
Yes No
3 nodules ≤ 3 cm
Increased
Normal
1 HCC
Stage D PST > 2, Child–Pugh C
Intermediate stage (B)
Multinodular, PST 0
Advanced stage (C) Portal invasion, N1, M1, PST 1–2
Stage A–C PST 0–2, Child–Pugh A–B
Adapted from Bruix J, Sherman M. Hepatology. In press 2010.
Available from Last accessed September Llovet JM, et al. J Natl Cancer Inst. 2008;100:

5. BCLC guidelines HCC Portal pressure/ bilirubin PEI/RFA Sorafenib
Stage 0 PST 0, Child–Pugh A
Very early stage (0)
1 HCC < 2 cm Carcinoma in situ
Early stage (A)
1 HCC or 3 nodules < 3 cm, PST 0
End stage (D)
Liver transplantation
TACE
Resection
Symptomatic treatment (20%)
Survival < 3 months
Curative treatments (30%)
5-year survival (40–70%)
Palliative treatments (50%)
Median survival 11–20 months
Associated diseases
Yes No
3 nodules ≤ 3 cm
Increased
Normal
1 HCC
Stage D PST > 2, Child–Pugh C
Intermediate stage (B)
Multinodular, PST 0
Advanced stage (C) Portal invasion, N1, M1, PST 1–2
Stage A–C PST 0–2, Child–Pugh A–B
Adapted from Bruix J, Sherman M. Hepatology. In press 2010.
Available from Last accessed September Llovet JM, et al. J Natl Cancer Inst. 2008;100: