IHPBA 2026 global guideline for the management of hepatocellular carcinoma in resource-constrained healthcare settings.

BACKGROUND

Current guidelines for the management of patients with HCC are predominantly focused on well-resourced healthcare systems. In 2024, the IHPBA Legacy committee initiated a process to develop global resource-sensitive guidelines for the management of HCC.

METHODS

An IHPBA global guideline group produced and circulated statements on the management of HCC from diagnosis to treatment, discussed these in online webinars and generated guidelines. This document focuses on the diagnosis and management of patients with HCC in resource-constrained healthcare settings.

RESULTS

Initial diagnosis by ultrasound is supported by cross-sectional imaging. Alfa-feto protein and assessment of liver synthetic function are recommended at diagnosis. Lesion biopsy is not mandated. Liver resection is the recommended treatment of choice for single HCC in patients with preserved liver function and up to 3 lesions ≤3 cm. Radiofrequency and microwave are regarded as equivalent and can be used if resection is not available. Ethanol injection can be used if thermal ablation is not available but should be restricted to small lesions. TACE and TAE can be used for intermediate stage disease. Atezolizumab/bevacizumab combination is recommended as first line systemic therapy with sorafenib and Lenvatinib being recommended if first line is not an option. Advice for the care of the patient with advanced or terminal disease is provided.

CONCLUSIONS

This document provides resource-sensitive HCC guidelines that prioritise feasibility, maximise benefit, and reduce default reliance on best supportive care alone and are produced for the IHPBA by discussion with the global community of IHPBA.