An analysis of the updated Chinese “Guideline for Diagnosis and Treatment of Primary Liver Cancer (2026 Edition)” and a comparison with guidelines from Europe and the United States_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LI Jingdong , XIAO Yuzhu

First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

LI Jingdong, Email: lijingdong358@126.com

Keywords：

hepatocellular carcinoma; Chinese liver cancer guideline; European and American liver cancer guideline; comparative interpretation

DOI：

10.7507/1007-9424.202605045

Video：

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Hepatocellular carcinoma is a highly prevalent malignant tumor worldwide, and its mortality rate remains persistently high, making it a major threat to human health and life. Recently, China updated its guidelines for the diagnosis and treatment of hepatocellular carcinoma, releasing the “Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2026 Edition)”. This article provides an updated interpretation of this guideline and conducts a systematic comparison with authoritative domestic and international guidelines published between 2023 and 2026, including those from the American Association for the Study of Liver Diseases, the National Comprehensive Cancer Network, the European Association for the Study of the Liver, and the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2024 Edition). The Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2026 Edition) significantly elevates the role of systemic therapy, emphasizing comprehensive treatment aimed at surgical resection (translational therapy, neoadjuvant therapy, and adjuvant therapy). Significant progress has also been made in the combination of local therapy with systemic therapy, as well as in first- and second-line treatment regimens for advanced disease. At the same time, the study compares and analyzes the similarities and differences among various guidelines regarding screening, diagnosis, and treatment decisions, aiming to provide a reference and guidance for standardized and personalized clinical diagnosis and treatment of hepatocellular carcinoma in China.

Citation： LI Jingdong, XIAO Yuzhu. An analysis of the updated Chinese “Guideline for Diagnosis and Treatment of Primary Liver Cancer (2026 Edition)” and a comparison with guidelines from Europe and the United States. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(7): 865-874. doi: 10.7507/1007-9424.202605045 Copy

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1. 中華人民共和國國家衛生健康委員會醫政司. 原發性肝癌診療指南 (2024年版). 中華消化外科雜志, 2024, 23(4): 429-478.
2. 中華人民共和國國家衛生健康委員會醫政司. 原發性肝癌診療指南 (2026年版). 中國普外基礎與臨床雜志, 2026, 33(4): 425-485.
3. Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology, 2023, 78(6): 1922-1965.
4. Taddei TH, Brown DB, Yarchoan M, et al. Critical update: AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology, 2025, 82(1): 272-274.
5. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol, 2025, 82(2): 315-374.
6. Chan SL, Sun HC, Xu Y, et al. The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment. Lancet, 2025, 406(10504): 731-778.
7. Fan R, Papatheodoridis G, Sun J, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. J Hepatol, 2020, 73(6): 1368-1378.
8. Fan R, Chen L, Zhao S, et al. Novel, high accuracy models for hepatocellular carcinoma prediction based on longitudinal data and cell-free DNA signatures. J Hepatol, 2023, 79(4): 933-944.
9. Piratvisuth T, Hou J, Tanwandee T, et al. Development and clinical validation of a novel algorithmic score (GAAD) for detecting HCC in prospective cohort studies. Hepatol Commun, 2023, 7(11): e0317. doi: 10.1097/HC9.0000000000000317.
10. Yang T, Xing H, Wang G, et al. A novel online calculator based on serum biomarkers to detect hepatocellular carcinoma among patients with hepatitis B. Clin Chem, 2019, 65(12): 1543-1553.
11. Zhou J, Yu L, Gao X, et al. Plasma microRNA panel to diagnose hepatitis B virus-related hepatocellular carcinoma. J Clin Oncol, 2011, 29(36): 4781-4788.
12. Zhou C, Li G, Quan Z, et al. Prospective study comparing [^99mTc]Tc-DP-FAPI quantitative SPECT/CT with [⁶⁸Ga]Ga-FAPI-04 PET/CT in patients with gastrointestinal tumors. Mol Pharm, 2024, 21(10): 5297-5304.
13. Duan Y, Xie X, Li Q, et al. Differentiation of regenerative nodule, dysplastic nodule, and small hepatocellular carcinoma in cirrhotic patients: a contrast-enhanced ultrasound-based multivariable model analysis. Eur Radiol, 2020, 30(9): 4741-4751.
14. Quaia E. State of the art: LI-RADS for contrast-enhanced US. Radiology, 2019, 293(1): 4-14.
15. Wang H, Qian YW, Sheng X, et al. Deciphering the significance of tumor necrosis and developing a grading system in combined hepatocellular-cholangiocarcinoma: a multicenter pathological study. Pathol Res Pract, 2026, 278: 156335. doi: 10.1016/j.Prp.2025.156335.
16. Benedetti Cacciaguerra A, G?rgec B, Lanari J, et al. Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis. J Hepatobiliary Pancreat Sci, 2022, 29(11): 1226-1239.
17. Glantzounis GK, Tokidis E, Basourakos SP, et al. The role of portal vein embolization in the surgical management of primary hepatobiliary cancers. A systematic review. Eur J Surg Oncol, 2017, 43(1): 32-41.
18. Zhang Y, Huang G, Wang Y, et al. Is salvage liver resection necessary for initially unresectable hepatocellular carcinoma patients downstaged by transarterial chemoembolization? Ten years of experience. Oncologist, 2016, 21(12): 1442-1449.
19. Lyu N, Kong Y, Mu L, et al. Hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin vs. sorafenib for advanced hepatocellular carcinoma. J Hepatol, 2018, 69(1): 60-69.
20. Sun HC, Fan J, Shen F, et al. 1469MO liver resection versus continued atezolizumab plus bevacizumab (atezo/bev) in locally advanced hepatocellular carcinoma (HCC) after atezo/bev treatment (TALENTop): a multicenter, open-label, randomized phase Ⅲ trial. Annals Oncol, 2025, 36(S2): S885. doi: 10.1016/j.Annonc.2025.08.2099.
21. Wang Z, Fan J, Zhou S, et al. Perioperative camrelizumab plus rivoceranib versus surgery alone in patients with resectable hepatocellular carcinoma at intermediate or high risk of recurrence (CARES-009): a randomised phase 2/3 trial. Lancet, 2025, 406(10515): 2089-2099.
22. Tsilimigras DI, Bagante F, Moris D, et al. Recurrence patterns and outcomes after resection of hepatocellular carcinoma within and beyond the barcelona clinic liver cancer criteria. Ann Surg Oncol, 2020, 27(7): 2321-2331.
23. Wei W, Jian PE, Li SH, et al. Adjuvant transcatheter arterial chemoembolization after curative resection for hepatocellular carcinoma patients with solitary tumor and microvascular invasion: a randomized clinical trial of efficacy and safety. Cancer Commun (Lond), 2018, 38(1): 61. doi: 10.1186/s40880-018-0331-y.
24. Peng Z, Fan W, Liu Z, et al. Adjuvant transarterial chemoembolization with sorafenib for portal vein tumor thrombus: a randomized clinical trial. JAMA Surg, 2024, 159(6): 616-624.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

An analysis of the updated Chinese “Guideline for Diagnosis and Treatment of Primary Liver Cancer (2026 Edition)” and a comparison with guidelines from Europe and the United States

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