Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of hepatic decompensation and liver-related death, but most patients with MASLD do not develop these liver-related complications. Risk prediction and care pathways are crucial to identify which patients with MASLD are highest risk and link them to appropriate care. Risk prediction is usually done with blood-based algorithms such as Fibrosis-4 (FIB4), AST/platelet ratio index (APRI), and more recent scores such as steatotic-associated fibrosis estimator (SAFE) and LiverRisk Score. Second-line tests include Enhanced Liver Fibrosis (ELF) and imaging-based tests such as vibration-controlled transient elastography, shear wave elastography, or magnetic resonance elastography. We propose a consensus risk stratification care pathway that can be adapted for different clinical settings. We also discuss key needs to improve upon the state of the art: improving diagnosis/prognostic accuracy especially of blood-based models, optimizing calibration, and ensuring interpretability of predictive models. Finally, we discuss recent advances in clinical decision support systems including best practice advisories, dashboards, and dynamic guidelines. We highlight factors critical to clinical decision support systems including integration with existing systems and clinician workflows, minimizing additional burden to clinicians, provision of decision support and recommendations at the time/place of decision making, and continuous evaluation and local user involvement.
Factors Influencing Overall Survival Period of Stage IV Cancer Patients Wen Pei Chang, Yen Kuang Lin, Shashank Kaushik European Journal of Cancer Care.2025;[Epub] CrossRef
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Hepatocellular carcinoma (HCC) is highly prevalent and the third most common cause of cancer-related death in Asia. In contrast to the West, the main etiology of HCC in many Asian countries except Japan is chronic hepatitis B virus infection. Differences in the major causes of HCC lead to significant clinical and treatment differences. This review summarizes and compares guidelines on managing HCC from China, Hong Kong, Taiwan, Japan, and South Korea. From oncology and socio-economic perspectives, factors such as underlying diseases, staging methods, government policies, insurance coverage, and medical resources contribute to varying treatment strategies among countries. Furthermore, the differences in each guideline are fundamentally caused by the lack of incontrovertible medical evidence, and even existing results of clinical trials can be interpreted differently. This review will provide a complete overview of the current Asian guidelines for HCC in recommendations and in practice.
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Hepatocellular carcinoma (HCC) is a major cause of death in many countries, including South Korea. To provide useful and sensible advice for clinical management of patients with HCC, the Korean Liver Cancer Association and National Cancer Center Korea Practice Guideline Revision Committee have recently revised the practice guidelines for HCC management. However, there are some differences between practice guidelines and real-life clinical practice. In this review, we describe some key recommendations of the 2022 version of practice guidelines and the real-life clinical situation in South Korea, together with discussion about efforts needed to reduce the difference between guidelines and real-life clinical practice.
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Clinical practice guidelines are important for guiding the management of specific diseases by medical practitioners, trainees, and nurses. In some cases, the guidelines are utilized as a reference for health policymakers in controlling diseases with a large public impact. With this in mind, practice guidelines for the management of chronic hepatitis B (CHB) have been developed in the United States, Europe, and Asian-Pacific regions to suggest the best-fit recommendations for each social and medical circumstance. Recently, the Korean Association for the Study of the Liver published a revised version of its clinical practice guidelines for the management of CHB. The guidelines included updated information based on newly available antiviral agents, the most recent opinion on the initiation and cessation of treatment, and updates for the management of drug resistance, partial virological response, and side effects. Additionally, CHB management in specific situations was comprehensively revised. This review compares the similarities and differences among the various practice guidelines to identify unmet needs and improve future recommendations.
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