Journal Article
. 2021 May; 19(5):541-565.
doi: 10.6004/jnccn.2021.0022.

Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

Al B Benson 1 Michael I D'Angelica 2 Daniel E Abbott 3 Daniel A Anaya 4 Robert Anders 5 Chandrakanth Are 6 Melinda Bachini 7 Mitesh Borad 8 Daniel Brown 9 Adam Burgoyne 10 Prabhleen Chahal 11 Daniel T Chang 12 Jordan Cloyd 13 Anne M Covey 2 Evan S Glazer 14 Lipika Goyal 15 William G Hawkins 16 Renuka Iyer 17 Rojymon Jacob 18 R Kate Kelley 19 Robin Kim 20 Matthew Levine 21 Manisha Palta 22 James O Park 23 Steven Raman 24 Sanjay Reddy 25 Vaibhav Sahai 26 Tracey Schefter 27 Gagandeep Singh 28 Stacey Stein 29 Jean-Nicolas Vauthey 30 Alan P Venook 19 Adam Yopp 31 Nicole R McMillian 32 Cindy Hochstetler 32 Susan D Darlow 32 
Affiliations
  • PMID: 34030131
  •     36 citations

Abstract

The NCCN Guidelines for Hepatobiliary Cancers focus on the screening, diagnosis, staging, treatment, and management of hepatocellular carcinoma (HCC), gallbladder cancer, and cancer of the bile ducts (intrahepatic and extrahepatic cholangiocarcinoma). Due to the multiple modalities that can be used to treat the disease and the complications that can arise from comorbid liver dysfunction, a multidisciplinary evaluation is essential for determining an optimal treatment strategy. A multidisciplinary team should include hepatologists, diagnostic radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary cancer expertise. In addition to surgery, transplant, and intra-arterial therapies, there have been great advances in the systemic treatment of HCC. Until recently, sorafenib was the only systemic therapy option for patients with advanced HCC. In 2020, the combination of atezolizumab and bevacizumab became the first regimen to show superior survival to sorafenib, gaining it FDA approval as a new frontline standard regimen for unresectable or metastatic HCC. This article discusses the NCCN Guidelines recommendations for HCC.

Development and Validation of a Prognostic Nomogram Based on the Systemic Immune-Inflammation Index for Resectable Gallbladder Cancer to Predict Survival and Chemotherapy Benefit.
Lin Li, Tai Ren, +12 authors, Ying-Bin Liu.
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The Role of Fine Needle Aspiration Cytology in the Diagnosis of Gallbladder Cancer: A Systematic Review.
Georgios D Koimtzis, Christopher G Chalklin, +3 authors, Christoforos S Kosmidis.
Diagnostics (Basel), 2021 Aug 28; 11(8). PMID: 34441361    Free PMC article.
Review.
Screening potential prognostic biomarkers for portal vein emboli in patients with hepatocellular carcinoma.
Weijie Zhou, Da Lang Fang, Yongfei He.
J Gastrointest Oncol, 2021 Sep 18; 12(4). PMID: 34532139    Free PMC article.
Nomogram to Predict the Survival of Chinese Patients with Alcohol-Related Liver Disease.
Fangfang Duan, Chen Liu, +5 authors, Song Yang.
Can J Gastroenterol Hepatol, 2021 Oct 08; 2021. PMID: 34616695    Free PMC article.
Atezolizumab and bevacizumab as first line therapy in advanced hepatocellular carcinoma: Practical considerations in routine clinical practice.
Ankit Jain, Shivakumar Chitturi, Geoffrey Peters, Desmond Yip.
World J Hepatol, 2021 Oct 12; 13(9). PMID: 34630880    Free PMC article.
Review.
Case Report: Antiangiogenic Therapy Plus Immune Checkpoint Inhibitors Combined With Intratumoral Cryoablation for Hepatocellular Carcinoma.
Xin Li, Jiahua Xu, +6 authors, Jianxin Qian.
Front Immunol, 2021 Nov 05; 12. PMID: 34733279    Free PMC article.
Optimal Management of Patients with Advanced or Metastatic Cholangiocarcinoma: An Evidence-Based Review.
Dina Ioffe, Pooja Phull, Efrat Dotan.
Cancer Manag Res, 2021 Nov 06; 13. PMID: 34737637    Free PMC article.
Review.
Interpretation of NCCN guidelines for hepatobiliary tumors V3 update in 2021.
Lingxiao Xu, Jun Zhou.
Hepatobiliary Surg Nutr, 2021 Nov 12; 10(5). PMID: 34760973    Free PMC article.
Evaluating the Effectiveness of Yttrium-90 Glass Microspheres in the Treatment of Hepatocellular Carcinoma, Intrahepatic Cholangiocarcinoma, and Metastatic Colorectal Cancer in Practice: Protocol for the Prospective PROACTIF Phase IV Registry Study in France.
Etienne Garin, Jean-Baptiste Pinaquy, +22 authors, PROACTIF registry group.
Cardiovasc Intervent Radiol, 2021 Nov 20; 45(1). PMID: 34796373    Free PMC article.
Identification and clinical validation of EMT-associated prognostic features based on hepatocellular carcinoma.
Dafeng Xu, Yu Wang, +3 authors, Jinfang Zheng.
Cancer Cell Int, 2021 Nov 26; 21(1). PMID: 34819088    Free PMC article.
Clinical application of advances and innovation in radiation treatment of hepatocellular carcinoma.
Valerie J W Tong, Vishal G Shelat, Yew Kuo Chao.
J Clin Transl Res, 2022 Jan 07; 7(6). PMID: 34988334    Free PMC article.
Review.
Clinical Evaluation of Ramucirumab for the Treatment of Hepatocellular Carcinoma (HCC): Place in Therapy.
Khalil Choucair, Syed Kamran, Anwaar Saeed.
Onco Targets Ther, 2022 Jan 11; 14. PMID: 35002257    Free PMC article.
Review.
Meta-Analysis of Postoperative Adjuvant Hepatic Artery Infusion Chemotherapy Versus Surgical Resection Alone for Hepatocellular Carcinoma.
Qiao Ke, Lei Wang, +4 authors, Wuhua Guo.
Front Oncol, 2022 Jan 11; 11. PMID: 35004268    Free PMC article.
Systematic Review.
A Pyroptosis-Based Prognostic Model for Immune Microenvironment Estimation of Hepatocellular Carcinoma.
Zhihong Chen, Yiping Zou, +4 authors, Ning Shi.
Dis Markers, 2022 Jan 21; 2022. PMID: 35047095    Free PMC article.
Case Report: Addition of PD-1 Antibody Camrelizumab Overcame Resistance to Trastuzumab Plus Chemotherapy in a HER2-Positive, Metastatic Gallbladder Cancer Patient.
Li Wang, Xiaomo Li, +7 authors, Dong Yan.
Front Immunol, 2022 Jan 25; 12. PMID: 35069555    Free PMC article.
The new insight of treatment in Cholangiocarcinoma.
Yuhang Li, Yinghui Song, Sulai Liu.
J Cancer, 2022 Jan 25; 13(2). PMID: 35069894    Free PMC article.
Review.
Optimizing the Diagnosis and Biomarker Testing for Patients with Intrahepatic Cholangiocarcinoma: A Multidisciplinary Approach.
May T Cho, Sepideh Gholami, +9 authors, Farshid Dayyani.
Cancers (Basel), 2022 Jan 22; 14(2). PMID: 35053557    Free PMC article.
Review.
Immunotherapy in liver transplantation for hepatocellular carcinoma: Pros and cons.
Yi Luo, Fei Teng, Hong Fu, Guo-Shan Ding.
World J Gastrointest Oncol, 2022 Feb 05; 14(1). PMID: 35116109    Free PMC article.
Review.
Age-specific clinicopathological characteristics and prognostic analysis of neuroendocrine carcinomas of the gallbladder.
Zhiwei Zhang, Tong Guo, +3 authors, Yahong Yu.
Cancer Med, 2021 Nov 30; 11(3). PMID: 34841738    Free PMC article.
Modulation of the tumour microenvironment in hepatocellular carcinoma by tyrosine kinase inhibitors: from modulation to combination therapy targeting the microenvironment.
Ruyin Chen, Qiong Li, +5 authors, Jian Ruan.
Cancer Cell Int, 2022 Feb 13; 22(1). PMID: 35148789    Free PMC article.
Review.
Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature.
Christopher T Aquina, Mariam F Eskander, Timothy M Pawlik.
Front Oncol, 2022 Feb 18; 12. PMID: 35174097    Free PMC article.
Review.
Focal neuroendocrine carcinoma mixed with adenocarcinoma of the gallbladder with aggressive lymph node metastasis in a patient who did not meet the mixed neuroendocrine-non-neuroendocrine neoplasm criteria.
Yoshie Kadota, Shinsuke Funakoshi, +8 authors, Hirohisa Harada.
Clin J Gastroenterol, 2021 Nov 13; 15(1). PMID: 34767241    Free PMC article.
Associations of DDX60L With the Clinical Features and Prognosis of Hepatocellular Carcinoma.
Ziqi Ye, Xin Zhang, +3 authors, Ping Huang.
Front Oncol, 2022 Mar 01; 12. PMID: 35223465    Free PMC article.
Associations of Racial and Ethnic Category, Age, Comorbidities, and Socioeconomic Factors on Concordance to NCCN Guidelines for Patients With High-Risk Biliary Tract Cancers After Surgery.
Lauren F Huang, Augustine Hong, +11 authors, Richard T Lee.
Front Oncol, 2022 Mar 12; 12. PMID: 35273909    Free PMC article.
Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients.
Jin Hean Koh, Darren Jun Hao Tan, +12 authors, Daniel Q Huang.
Hepatobiliary Surg Nutr, 2022 Mar 15; 11(1). PMID: 35284509    Free PMC article.
Lenvatinib Plus Camrelizumab vs. Lenvatinib Monotherapy as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Multicenter Retrospective Cohort Study.
Qi Li, Mengran Cao, +9 authors, Jinzhang Chen.
Front Oncol, 2022 Mar 15; 12. PMID: 35280760    Free PMC article.
Transarterial Chemoembolization Combined With Lenvatinib Plus PD-1 Inhibitor for Advanced Hepatocellular Carcinoma: A Retrospective Cohort Study.
Mingyue Cai, Wensou Huang, +9 authors, Kangshun Zhu.
Front Immunol, 2022 Mar 19; 13. PMID: 35300325    Free PMC article.
Late combination of transarterial chemoembolization with apatinib and camrelizumab for unresectable hepatocellular carcinoma is superior to early combination.
Shuguang Ju, Chen Zhou, +10 authors, Bin Xiong.
BMC Cancer, 2022 Mar 30; 22(1). PMID: 35346114    Free PMC article.
Pyroptosis-Related Risk Signature Exhibits Distinct Prognostic, Immune, and Therapeutic Landscapes in Hepatocellular Carcinoma.
Yidi Zhao, Qingya Song, +3 authors, Zhengliang Zhang.
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Microvascular Invasion in Hepatocellular Carcinoma: A Review of Its Definition, Clinical Significance, and Comprehensive Management.
Zehao Zheng, Renguo Guan, +5 authors, Zhixiang Jian.
J Oncol, 2022 Apr 12; 2022. PMID: 35401743    Free PMC article.
Review.
Laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: study protocol for a multicentre randomised controlled trial.
Shutao Pan, Tingting Qin, +14 authors, Minimally Invasive Treatment Group in the Pancreatic Disease Branch of China’s International Exchange and Promotion Association for Medicine and Healthcare (MITG-P-CPAM).
BMJ Open, 2022 Apr 06; 12(4). PMID: 35379633    Free PMC article.
Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma.
Jungnam Lee, Young-Joo Jin, +9 authors, Young Seok Kim.
Clin Mol Hepatol, 2021 Nov 24; 28(2). PMID: 34814239    Free PMC article.
Molecular pathogenesis and systemic therapies for hepatocellular carcinoma.
Josep M Llovet, Roser Pinyol, +5 authors, Augusto Villanueva.
Nat Cancer, 2022 Apr 29; 3(4). PMID: 35484418    Free PMC article.
Review.
Prognostic factors of recurrent intrahepatic cholangiocarcinoma after hepatectomy: A retrospective study.
Zi-Bo Yuan, Hong-Bo Fang, +2 authors, Jie Li.
World J Gastroenterol, 2022 May 19; 28(15). PMID: 35582131    Free PMC article.
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Kun-Liang Feng, Na Diao, +5 authors, Chong Zhong.
Front Cell Dev Biol, 2022 May 21; 10. PMID: 35592246    Free PMC article.
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Peng Cao, Haijie Hong, +2 authors, Shuo Qi.
Front Nutr, 2022 May 24; 9. PMID: 35600830    Free PMC article.