Table 6 The possible therapeutic choices of hepatocellular carcinoma

Hepatectomy

Ia

Surgical resection

Ib

IIa

IIb

Preoperative neoadjuvant therapy, induction or conversion therapy may be considered.

IIIa

IIIb

Adjuvant therapy after hepatectomy

Interventional therapy; Immunotherapy; Chemotherapy and targeted therapy.

Liver transplantation

Transplantation criteria: Milan Criteria.

Treatment while waiting for a donor liver.

Ablation therapy

Ia

1. Radiofrequency ablation

2. Microwave ablation

3. Cryotherapy

4. Percutaneous ethanol injection therapy

Ib

Hepatic arterial interventional therapy

Ia

TACE (Not suitable or refused surgical resection, Liver transplantation and ablation therapy).

Ib

IIa

IIb

1. TACE

2. TACE + Sorafenib

IIIa

TACE (The main portal vein of the liver is incompletely blocked, or although it is completely blocked, the compensatory collateral vessels between the hepatic artery and the portal vein are formed).

IIIb

TACE + systemic therapy

IV

TACE / HAIC (Liver transplantation could not or refused to be performed).

Radiotherapy

1. Small hepatocellular carcinoma is not suitable for surgery or unwilling to surgery

2. Combined with TACE treatment

3. Treatment before liver transplantation

4. Hepatic portal vein or inferior vena cava tumor thrombus

5. Patients with extrahepatic metastasis

Radionuclide immunotherapy

I

1. HCC combined with TACE treatment, and not suitable for or refused surgical resection, liver transplantation and ablation therapy.

2. Patients who were not suitable for or refused surgical resection and liver transplantation after RFA.

II

First-line immunotherapy, chemotherapy and targeted drug therapy for advanced liver cancer

Hepatic function ChildPugh

A or B ( = < 7)

1. Sorafenib

2. Systemic chemotherapy based on oxaliplatin

3. Lenvatinib

4. Donafenib

5. Atezolizumzb + bevacizumab

6. Lenvatinib + Paporizumab or navulizumab

Hepatic function ChildPugh

B (> 7) and C

Best supportive care; Palliative treatment

Second-line immunotherapy, chemotherapy and targeted drug therapy for advanced liver cancer

Hepatic function ChildPugh A or B ( = < 7)

1. Regorafenib2. Ramucirumab (AFP > 400ng/ml)

3. Cabozantinib

4. Those who have used sorafenib in the past can consider Carrelizumab + FOLFOX4

5. These who have previously used oxaliplatin can consider Carrelizumab combined with Apatinib

Hepatic function ChildPugh

B (> 7) and C

Best supportive care; Palliative treatment