Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. There are no consensus guidelines on diagnosis and management of HCC in India. The Indian National Association for Study of the Liver (INASL) set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines for diagnosis and management of HCC, relevant to disease patterns and clinical practices in India. The Task-Force first identified various contentious issues on various aspects of HCC and these issues were allotted to individual members of the Task-Force who reviewed them in detail. The Task-Force used the Oxford Center for Evidence Based Medicine-Levels of Evidence of 2009 for developing an evidence-based approach. A 2-day round table discussion was held on 9th and 10th February, 2013 at Puri, Odisha, to discuss, debate, and finalize the consensus statements. The members of the Task-Force reviewed and discussed the existing literature at this meeting and formulated the INASL consensus statements for each of the issues. We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HCC in India.
Keywords: AFP, alpha-fetoprotein; AIIMS, All India Institute of Medical Sciences; ASMR, age standardized mortality rate; BCLC, Barcelona-Clinic Liver Cancer; CEUS, contrast enhanced ultrasound; CT, computed tomography; DCP, des-gamma-carboxy prothrombin; DDLT, deceased donor liver transplantation; DE, drug eluting; FNAC, fine needle aspiration cytology; GPC-3, glypican-3; GS, glutamine synthase; Gd-EOB-DTPA, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid; HBV, Hepatitis B virus; HCC, hepatocellular carcinoma; HCV, Hepatitis C virus; HSP-70, heat shock protein-70; HVPG, hepatic venous pressure gradient; ICG, indocyanine green; ICMR, Indian Council of Medical Research; INASL, Indian National Association for Study of the Liver; LDLT, living donor liver transplantation; MRI, magnetic resonance imaging; Mabs, monoclonal antibodies; NAFLD, non-alcoholic fatty liver disease; OLT, orthotopic liver transplantation; PAI, percutaneous acetic acid injection; PEI, percutaneous ethanol injection; PET, positron emission tomography; PVT, portal vein thrombosis; RECIST, Response Evaluation Criteria in Solid Tumors; RFA; RFA, radio frequency ablation; SVR, sustained viral response; TACE; TACE, transarterial chemoembolization; TART, trans-arterial radioisotope therapy; UCSF, University of California San Francisco; liver cancer; targeted therapy; transplant.