Journal of Liver Cancer

Special Contribution

Expert survey on systemic therapy indications for hepatocellular carcinoma in Korea: bridging clinical practice and reimbursement criteria: Hyun Yang, Soon Sun Kim, Seong Hee Kang, Jieun Kwon, Do Young Kim, Eunju Kim, Hyun Phil Shin, Jeong Il Yu, Jeong-Ju Yoo, Eileen L. Yoon, Sangheun Lee, Young Eun Chon, Janghan Jung, Jaekyung Cheon, Woosun Choi, Seul Ki Han, Ji Eun Han, Moon Haeng Hur, Hyun Woong Lee, Hyung Joon Kim; J Liver Cancer. 2025;25(2):160-168. Published online July 7, 2025; DOI: https://doi.org/10.17998/jlc.2025.07.02

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This survey aimed to collect expert opinions from multidisciplinary specialists involved in the management of hepatocellular carcinoma (HCC) in Korea regarding real-world criteria for systemic therapy indications. In response to discrepancies between national reimbursement policies and clinical decision-making, members of the Korean Liver Cancer Association and Korean Association for the Study of the Liver participated in a web-based survey from February 4 to 14, 2025. A total of 89 respondents, primarily experienced clinicians, provided their views on major clinical scenarios including infiltrative HCC, bilobar multifocal disease, huge tumors, vascular invasion, extrahepatic metastasis, and transarterial chemoembolization (TACE) refractoriness. There was high agreement for including infiltrative HCC (69.7%), suspected portal vein invasion (70.8%), and TACE refractoriness (82.0%) as systemic therapy indications. TACE refractoriness, in particular, aligns with current guideline definitions. Additionally, over half of respondents (51.7%) supported extrahepatic metastasis under similar conditions. Notably, multidisciplinary discussion was emphasized across scenarios, but many respondents also favored allowing primary physician discretion in select cases. This report provides consolidated expert input to inform future updates to reimbursement policies and promote alignment with real-world clinical practice. These findings may help bridge the gap between national coverage criteria and clinical decision in systemic therapy for HCC.

Citations

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Real-world outcomes of lenvatinib versus sorafenib as the second-line therapy after atezolizumab plus bevacizumab in patients with hepatocellular carcinoma: a large-scale multicenter study in Korea
Min Ji Lee, Subin Lim, Jae Yong Shim, Mi Na Kim, DongKyu Kim, Kyu‑pyo Kim, Kang Mo Kim, Baek‑Yeol Ryoo, Won‑Mook Choi, Hyun‑Jeong Kim, Seung‑Hoon Lee, Gaeun Kang, Mira Kang, Won Chul Cha, Jung Yong Hong, Woo Kyoung Jeong, Sung Kyung Ju, Jung‑Hyun Won, Doi
Hepatology International.2026;[Epub] CrossRef

Original Article

The efficacy of treatment for hepatocellular carcinoma in elderly patients: Han Ah Lee, Sangheun Lee, Hae Lim Lee, Jeong Eun Song, Dong Hyeon Lee, Sojung Han, Ju Hyun Shim, Bo Hyun Kim, Jong Young Choi, Hyunchul Rhim, Do Young Kim; J Liver Cancer. 2023;23(2):362-376. Published online September 14, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.03

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Abstract PDF Supplementary Material

Background/Aim
Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established.
Methods
Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC.
Results
Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05).
Conclusions
Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.

Citations

Citations to this article as recorded by

Management of hepatocellular carcinoma in older patients – An overview
Joseph Dao, Ananya Uddanti, Bryant Morocho, Ponnandai Somasundar, Steve Kwon
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Effect of Direct‐Acting Antivirals on Prognosis in Older Patients With Hepatitis C Virus‐Related Hepatocellular Carcinoma After Curative Therapy: A Retrospective Study by the Red Cross Liver Study Group in Japan
Hironori Ochi, Masayuki Kurosaki, Takaaki Tanaka, Takehiro Akahane, Hiroyuki Marusawa, Haruhiko Kobashi, Hideki Fujii, Atsuhiro Morita, Yasushi Uchida, Kazuhiko Okada, Naohito Urawa, Nami Mori, Keiji Tsuji, Eisuke Okamoto, Chikara Ogawa, Masahiko Kondo, M
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An Image-Guided Combination Strategy: Immediate Hepatic Arterial Infusion of Nivolumab Following Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma
Sujing Zhang, Zheng Zheng, Changwang Zhang, Xueqian Liu, Xinlei Shi, Wenhua Ma
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Dina Ioffe, Efrat Dotan
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Fang Liu, Zhi Zou, Liuchang Zheng
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Sun Woong Kim, Jun Sik Yoon, Young Lee, Heejoon Jang
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Han Ah Lee
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Yusra Zarlashat, Abdul Ghaffar, Flora Guerra, Anna Picca
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The delayed cancer treatment and economic inequality in Korea: results of common cancers by the time-to-surgery
Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han
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Radiotherapy for Liver-Confined Hepatocellular Carcinoma in Elderly Patients with Comorbidity
Sun Hyun Bae, Young Seok Kim, Sang Gyune Kim, Jeong-Ju Yoo, Jae Myeong Lee, Sanghyeok Lim, Jae Hong Jung, Chan Kyu Kim
Cancers.2025; 18(1): 91. CrossRef
Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jin-Soo Lee, Dong Ah Park, Seungeun Ryoo, Jungeun Park, Gi Hong Choi, Jeong-Ju Yoo
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Achieving Sufficient Therapeutic Outcomes of Surgery in Elderly Hepatocellular Carcinoma Patients through Appropriate Selection
Han Ah Lee
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Case Reports

A Case of Partial Response of Hepatocellular Carcinoma Induced by Concurrent Chemoradiation and Hepatic Arterial Infusion Chemotherapy after Trans-Arterial Chemoembolization: Myung Eun Song, Sangheun Lee, Mi Na Kim, Dong-Jun Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han, Jinsil Seong, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(2):152-157. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.152

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Abstract PDF: A 63-year-old man patient was referred for treatment of infiltrative hepatocellular carcinoma with hilar invasion after transarterial chemoembolization. Serum alkaline phosphatase and bilirubin were elevated, liver dynamic CT showed infiltrative type mass in left hepatic lobe and right hepatic dome with hilar invasion and left intrahepatic duct dilatation. Also CT showed obliteration of left portal vein and metastasis of lymph node around common bile duct. He was diagnosed as hepatocellular carcinoma (UICC stage IV-A, BCLC stage C). With the percutaneous transhepatic biliary drainage and the concurrent chemoradiation therapy and the 4th cycle of hepatic arterial infusion chemotherapy for infiltrative mass, viable tumor was decreased in resectable size at eight months from initial diagnosis.

A Case of Recurred Hepatocellular Carcinoma after Treated by Trans-Arterial Chemoembolization: Sangheun Lee, Mi Na Kim, Young Eun Chon, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han; Journal of the Korean Liver Cancer Study Group. 2013;13(1):74-79. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.74

2,266 Views
5 Downloads

Abstract PDF: Hepatocelluar carcinoma (HCC) is the most common primary liver cancer in the world and the most prevalent cancer among patients liver cirrhosis. The management of HCC depends on tumor stage and the degree of liver dysfunction. Patients with intermediate-stage HCC are ineligible for surgical or local ablative treatments. Current treatment guidelines recommend trans-arterial chemoembolization (TACE) for intermediate stage of HCC. However, tumor recurrence after TACE is universal and the survival benefit is relatively small. Hence, new strategies are needed to improve the outcome of HCC patients undergoing TACE. Recently, the combination of target agents with TACE has shown promising overall survival in advanced HCC. It is necessary to investigate new treat strategy how to increase treatment outcome of advanced HCC by new treat strategy.

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