Special Report
Evidence-based Clinical Practice Guidelines for
Hepatocellular Carcinoma: The Japan Society of
Hepatology 2013 update (3rd JSH-HCC Guidelines)
Norihiro Kokudo, Kiyoshi Hasegawa, Masaaki Akahane, Hiroshi Igaki, Namiki Izumi,
Takafumi Ichida, Shinji Uemoto, Shuichi Kaneko, Seiji Kawasaki, Yonson Ku,
Masatoshi Kudo, Shoji Kubo, Tadatoshi Takayama, Ryosuke Tateishi, Takashi Fukuda,
Osamu Matsui, Yutaka Matsuyama, Takamichi Murakami, Shigeki Arii, Masatoshi Okazaki
and Masatoshi Makuuchi
The Committee for Revision of the Clinical Practice Guidelines for Hepatocellular Carcinoma, Tokyo, Japan
The 3rd version of Clinical Practice Guidelines for Hepatocel-
lular Carcinoma was revised by the Japan Society of
Hepatology, according to the methodology of evidence-based
medicine, which was published in October 2013 in Japanese.
Here, we briefly describe new or changed recommendations
with a special reference to the two algorithms for surveil-
lance, diagnosis, and treatment.
Key words: algorithm for surveillance and diagnosis,
algorithm for treatment, clinical practice guidelines, clinical
question, evidence-based medicine
INTRODUCTION
T
HE SECOND VERSION of Evidence-based Clinical
Practice Guidelines for Hepatocellular Carcinoma
(2nd JSH-HCC Guidelines) conducted by the Japan
Society of Hepatology (JSH) was published in 2009 in
Japanese, and its English version was released in 2010.
1
Because new knowledge and information have been
increasingly accumulated since the end-point of the
published work search in June 2007, the second revision
was initiated in September 2011, and the new third
version was published in October 2013 in Japanese.
As was the case in the first
2–4
and second
1
versions of
the JSH-HCC Guidelines, the third was strictly revised
by the methodology of evidence-based medicine. In the
revision procedures, we set a total of 57 clinical ques-
tions (CQ), constructed retrieval styles for each CQ, and
systematically searched scientific papers (n = 6750 in
total) published between July 2007 and December 2011
in the medical databases (PubMed and Medline) by
the retrieval styles. The entire published work search
formula is open to the public (https://www.jsh.or.jp/
English/), which has not been always the case in other
HCC guidelines. After critical reading of all abstracts
and sometimes whole manuscripts (when necessary)
for a total of 1648 relevant publications, we finally
selected a total of 596 papers, wrote recommen-
dations for each CQ and decided the grade of the
recommendations.
The full English version of the 3rd JSH Guidelines is
available including the retrieval styles for all clinical
questions on the JSH website (https://www.jsh.or.jp/
English/). Herein, we highlight the important revision
points in recommendations and algorithms in the new
guidelines.
ALGORITHM FOR SURVEILLANCE
AND DIAGNOSIS
T
HE FUNDAMENTAL STRATEGY for HCC surveil-
lance and diagnosis is demonstrated in a revised
Correspondence: Dr Norihiro Kokudo, Hepato-Biliary-Pancreatic
Surgery Division, Department of Surgery, Graduate School of
Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan. Email: kokudo-2su@h.u-tokyo.ac.jp
Received 8 November 2014; revision 10 December 2014; accepted 11
December 2014.
doi: 10.1111/hepr.12464
© 2015 The Japan Society of Hepatology 123
Hepatology Research 2015; 45: 123–127
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