Clinical guidelines for early hepatocellular carcinoma treatment options: a systematic review and bibliometric analysis

Chun-Ying Wu; Lee-Yuan Lin; Teng-Yu Lee; Yao-Chun Hsu; Chun-Chieh Yeh; Chiehfeng Chen; Yi-No Kang; Tsai-Wei Huang

doi:10.1097/JS9.0000000000001950

Clinical guidelines for early hepatocellular carcinoma treatment options: a systematic review and bibliometric analysis

Int J Surg. 2024 Jul 23;110(11):7234-7244. doi: 10.1097/JS9.0000000000001950. Online ahead of print.

Authors

Chun-Ying Wu^{1

2

3

4

5}, Lee-Yuan Lin^{6

7}, Teng-Yu Lee^{8

9}, Yao-Chun Hsu¹⁰, Chun-Chieh Yeh^{11

12

13}, Chiehfeng Chen^{14

15

16

17}, Yi-No Kang^{16

17}, Tsai-Wei Huang^{16

18

19

20}

Affiliations

¹ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Department of Public Health, China Medical University, Taichung, Taiwan.
⁶ School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁷ School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁸ Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.
⁹ Department of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁰ Division of Gastroenterology and Hepatology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
¹¹ School of Medicine, China Medical University Hospital, Taichung, Taiwan.
¹² Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.
¹³ Department of Surgery, Asian University Hospital, Asian University, Taichung, Taiwan.
¹⁴ Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁵ Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei, Taiwan.
¹⁶ Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
¹⁷ Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan.
¹⁸ Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹⁹ Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
²⁰ School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Abstract

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide, with treatment options including radiofrequency ablation (RFA) and surgical resection. This study evaluates the evolving guidelines for these treatments to identify the current consensus and divergences.

Method: We conducted a systematic review following PRISMA 2020 guidelines of documents from 2017-2024 by major liver societies. The AGREE-II framework assessed guideline quality. This study is registered with PROSPERO (CRDXXXX).

Results: We analyzed 23 guidelines and noted significant shifts in treatment recommendations over recent updates. This analysis reveals an increasing endorsement of RFA for certain patient groups and sustained strong support for surgical resection based on robust evidence levels. All demonstrated high quality, with the 2023 Japan Guidelines receiving the highest AGREE-II score. A significant finding was the low level of stakeholder involvement in the development of guidelines.

Conclusion: The study highlights the dynamic nature of clinical guidelines for early-stage HCC, underscoring the need for ongoing updates and direct, high-quality comparative studies. The evolving recommendations for RFA, especially its role in managing small, localized tumors, reflect its emerging importance in the treatment paradigm.