Hepatocellular Carcinoma (HCC)

Basic Overview

Primary liver cancer is the second leading cause of cancer-related death in China, with hepatocellular carcinoma (HCC) accounting for 85-90% of cases, followed by intrahepatic cholangiocarcinoma (ICC) and mixed hepatocellular-cholangiocarcinoma.

Etiology: Over 80% of HCC cases in China are caused by chronic hepatitis B virus (HBV) infection, with additional risk factors including hepatitis C virus (HCV) infection, alcoholic liver disease, non-alcoholic steatohepatitis (NASH), aflatoxin exposure, cirrhosis, and hereditary liver disease.
Clinical Manifestations: Early-stage HCC is almost entirely asymptomatic. Intermediate and advanced disease presents with right upper quadrant pain, abdominal distension, anorexia, unintended weight loss, jaundice, ascites, and lower extremity edema. Terminal disease presents with hepatic failure, variceal bleeding, and encephalopathy. Lung and bone are the most common distant metastatic sites.
Diagnosis: Abdominal ultrasound combined with serum alpha-fetoprotein (AFP), AFP-L3, and PIVKA-II is the standard for biannual screening in high-risk patients (chronic HBV/HCV carriers, cirrhosis patients). Contrast-enhanced CT/MRI with LI-RADS scoring is the gold standard for non-invasive clinical diagnosis of HCC (no biopsy required for typical lesions). Liver biopsy is reserved for indeterminate lesions. Staging is primarily based on the BCLC (Barcelona Clinic Liver Cancer) system, with mandatory HBV/HCV viral load testing and Child-Pugh liver function assessment.

Standard Treatment Modalities

Very Early/Early-Stage HCC (BCLC 0-A): Curative therapies are the standard of care, including surgical resection, liver transplantation, and thermal ablation (radiofrequency ablation [RFA] or microwave ablation [MWA]). These treatments achieve a 5-year OS rate of over 70%.
Intermediate-Stage HCC (BCLC B): Transarterial chemoembolization (TACE) is the gold standard, with combination therapies (TACE + ablation, TACE + targeted therapy/immunotherapy) recommended for high-burden disease.
Advanced-Stage HCC (BCLC C): Systemic therapy is the core of management. The first-line standard of care is immune checkpoint inhibitor combined with anti-angiogenic therapy. Multi-target TKIs are alternative first-line options. Locoregional therapies including TACE, HAIC, and radiotherapy are used as adjunctive treatment.
Terminal-Stage HCC (BCLC D): Best supportive care, symptomatic management, and palliative interventions are the mainstay, with liver transplantation considered for strictly selected patients.

Core Advantages of Treatment in China

Global Leadership in HBV-Related HCC Comprehensive Management

: China is the global epicenter of HBV-related HCC research and clinical care, with the CSCO HCC Guidelines recognized as a global authoritative guideline for HBV-related HCC.

Unmatched Curative Therapy Expertise and Innovation

: China performs the highest number of HCC surgical resections globally, with top-tier liver surgery centers completing over 5,000 liver resections annually. Chinese surgeons are global pioneers in precise anatomic liver resection, laparoscopic/robotic-assisted liver resection, and complex resection for large/giant HCC and tumors in high-risk locations, with 5-year OS rates equivalent to the world’s leading institutions. China is the second largest liver transplant country globally, with the China-developed Hangzhou Criteria expanding liver transplant indications for HCC, allowing more patients to access curative therapy while maintaining excellent long-term survival. China is also the global leader in microwave ablation (MWA), a domestic innovation superior to RFA for large, hypervascular HCC, with the procedure widely accessible in grassroots hospitals.

Global Dominance in Interventional Oncology for HCC

: China performs over 70% of the world’s TACE procedures annually, with unparalleled experience in TACE combination therapies. The China-developed FOLFOX-HAIC (hepatic artery infusion chemotherapy) regimen has demonstrated superior efficacy to TACE for large and locally advanced HCC in large-scale phase III trials, now widely adopted as a standard therapy globally. Radioembolization (SIRT) and drug-eluting bead TACE (DEB-TACE) are also widely available in top centers.

Exceptional Cost-Effectiveness

: The total cost of HCC treatment in China is only 1/5 to 1/7 of that in the U.S. or Europe, with high-quality domestic surgical devices, interventional consumables, targeted agents, and immunotherapies available at a fraction of the cost of imported products.