Wu Chun-Ying, Lin Lee-Yuan, Lee Teng-Yu, Hsu Yao-Chun, Yeh Chun-Chieh, Chen Chiehfeng, Kang Yi-No, Huang Tsai-Wei
Institute of Biomedical Informatics, National Yang Ming Chiao Tung University.
Health Innovation Center, National Yang Ming Chiao Tung University.
Int J Surg. 2024 Nov 1;110(11):7234-7244. doi: 10.1097/JS9.0000000000001950.
Hepatocellular carcinoma 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.
The authors conducted a systematic review following PRISMA 2020 guidelines of documents from 2017 to 2024 by major liver societies. The AGREE-II framework assessed guideline quality. This study is registered with PROSPERO (CRD42022342266).
The authors 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.
The study highlights the dynamic nature of clinical guidelines for early-stage hepatocellular carcinoma, 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.
肝细胞癌仍然是全球癌症相关死亡的主要原因，治疗选择包括射频消融（RFA）和手术切除。本研究评估了这些治疗方法不断演变的指南，以确定当前的共识和分歧。
作者按照PRISMA 2020指南，对主要肝脏学会2017年至2024年的文献进行了系统综述。AGREE-II框架评估了指南质量。本研究已在PROSPERO（CRD42022342266）注册。
作者分析了23项指南，并注意到在最近的更新中治疗建议有显著变化。该分析表明，基于有力的证据水平，对于某些患者群体，RFA的认可度在增加，而手术切除仍持续获得强烈支持。所有指南均显示出高质量，2023年日本指南获得了最高的AGREE-II评分。一个重要发现是利益相关者在指南制定中的参与程度较低。
该研究强调了早期肝细胞癌临床指南的动态性质，强调了持续更新以及直接、高质量比较研究的必要性。RFA不断演变的建议，尤其是其在治疗小的局限性肿瘤中的作用，反映了其在治疗模式中日益重要的地位。
