Expert Consensus
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2021; 27(47): 8069-8080
Published online Dec 21, 2021. doi: 10.3748/wjg.v27.i47.8069
Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma
Hai-Tao Zhao, Jian-Qiang Cai
Hai-Tao Zhao, Department of Hepatobiliary Surgery, Peking Union Medical College Hospital, Beijing 100021, China
Jian-Qiang Cai, Department of Hepatobiliary Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
Author contributions: Zhao HT was responsible for investigation, writing-original draft, reviewing, and editing; Cai JQ was responsible for conceptualization, supervision, and writing-review and editing; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The author has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Qiang Cai, MD, Professor, Department of Hepatobiliary Surgery, Cancer Hospital Chinese Academy of Medical Sciences, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. caijianqiang2021@163.com
Received: September 16, 2021
Peer-review started: September 16, 2021
First decision: October 16, 2021
Revised: October 27, 2021
Accepted: December 8, 2021
Article in press: December 8, 2021
Published online: December 21, 2021
Abstract

The low resection and high recurrence rates in hepatocellular carcinoma (HCC) are the major challenges to improving prognosis. Neoadjuvant and conversion therapies are underlying strategies to overcome these challenges. To date, no guideline or consensus has been published on the neoadjuvant and conversion therapies in HCC. Recent studies showed that neoadjuvant therapy for resectable HCC and conversion therapy for unresectable HCC are safe, feasible, and effective. Neoadjuvant and conversion therapies have the following advantages in treating HCC: R0 resection with sufficient volume of future liver remnant, relatively simple operation, and wide applicability. Therefore, it was necessary to conduct a widely accepted consensus among the experts in China who have extensive expertise and experience in treating HCC using neoadjuvant and conversion therapies, which is important to standardize the application of neoadjuvant and conversion therapies for the management of HCC. The strategies of neoadjuvant therapy include the selection of the eligible patients, therapy regimen, cycles, effect evaluations, and multidisciplinary treatment. The management of patients with insufficient volume of future liver remnant and patients who cannot achieve R0 resection is the key to the strategies of conversion therapy. Here, we present the resultant evidence- and experience-based consensus to guide the application of neoadjuvant and conversion therapies in clinical practice.

Keywords: Consensus, Hepatocellular carcinoma, Neoadjuvant therapy, Conversion therapy

Core Tip: Recent studies showed that neoadjuvant therapy for resectable hepatocellular carcinoma and conversion therapy for unresectable hepatocellular carcinoma are safe, feasible, and effective. It was necessary to conduct a widely accepted consensus among the experts in China who have extensive expertise and experience in treating hepatocellular carcinoma using neoadjuvant and conversion therapies.