title: The Indian National Association for Study of the Liver (INASL) Consensus on Prevention, Diagnosis and Management of Hepatocellular Carcinoma in India: The Puri Recommendations.
abstract: 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.
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Road, New Delhi 110 029, India.
authors.forename: Subrat K
authors.initials: SK
authors.lastname: Acharya
authors.affiliation: Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Shivaram P
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Saraswat
authors.affiliation: Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Duseja
authors.affiliation: Department of Gastroenterology, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal 700 054, India.
authors.forename: Mahesh K
authors.initials: MK
authors.lastname: Goenka
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepali
authors.initials: D
authors.lastname: Jain
authors.affiliation: Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India.
authors.forename: Premashish
authors.initials: P
authors.lastname: Kar
authors.affiliation: Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumaran
authors.affiliation: Department of Digestive Diseases, Tata Medical Center, Kolkata, West Bengal 700156, India.
authors.forename: Kunisshery M
authors.initials: KM
authors.lastname: Mohandas
authors.affiliation: Department of Oncology, Institute of Liver & Biliary Sciences, New Delhi, India.
authors.forename: Dipanjan
authors.initials: D
authors.lastname: Panda
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shashi B
authors.initials: SB
authors.lastname: Paul
authors.affiliation: Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu 632 004, India.
authors.forename: Jeyamani
authors.initials: J
authors.lastname: Ramachandran
authors.affiliation: Department of Surgical Gastroenterology, Lakeshore Hospital and Research Center, Cochin, Kerala, India.
authors.forename: Hariharan
authors.initials: H
authors.lastname: Ramesh
authors.affiliation: Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India.
authors.forename: Padaki N
authors.initials: PN
authors.lastname: Rao
authors.affiliation: Department of Gastroenterology, Jaslok Hospital and Research Centre, Peddar Road, Mumbai, Maharashtra 400 026, India.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Shah
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Road, New Delhi 110 029, India.
authors.forename: Hanish
authors.initials: H
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal 700 054, India.
authors.forename: Ragesh B
authors.initials: RB
authors.lastname: Thandassery
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