肝细胞癌（HCC）是全球癌症死亡的主要原因，约三分之一的患者出现中间期疾病。由于本地、局部和系统治疗的发展，中间期HCC的治疗格局正在快速演变。缺乏针对这种多样性疾病阶段，且考虑加拿大实情的治疗建议。为填补这一空白，加拿大囊肝学、移植、手术、放射治疗、核医学、介入放射学和医学肿瘤学领域专家组成的全加拿大团队齐聚一堂，制定了与加拿大情况相关的中间期HCC管理共识建议。采用修改后的Delphi框架制定共识声明，建议强度和支持证据级别使用AHA / ACC分类系统进行评分。根据系统搜索和专家意见，草拟临时的共识声明，然后通过在线调查进行流通，以评估达成协议的水平。在多学科治疗（n=4），肝动脉内治疗（n=14），生物制品（n=5），放射治疗（n=3），手术切除和移植（n=7），以及经皮消融治疗（n=4）领域的所有陈述都达到了预定批准门槛80%的协议。这些共识声明一般反映了治疗选择的扩大，这是由于以前已经建立或新出现的技术的发展，以及新型更有活力的治疗方法和治疗灵活性的增加所致。这些进展使得更好的治疗定制和个性化成为可能，同时在更广泛的疾病设置下实现治疗意图的范式转移。版权所有©2023。Elsevier Ltd.出版

Hepatocellular carcinoma (HCC) a leading cause of cancer mortality worldwide and approximately one-third of patients present with intermediate-stage disease. The treatment landscape of intermediate-stage HCC is rapidly evolving due to developments in local, locoregional and systemic therapies. Treatment recommendations focused on this heterogenous disease stage and that take into account the Canadian reality are lacking. To address this gap, a pan-Canadian group of experts in hepatology, transplant, surgery, radiation therapy, nuclear medicine, interventional radiology, and medical oncology came together to develop consensus recommendations on management of intermediate-stage HCC relevant to the Canadian context.A modified Delphi framework was used to develop consensus statements with strengths of recommendation and supporting levels of evidence graded using the AHA/ACC classification system. Tentative consensus statements were drafted based on a systematic search and expert input in a series of iterative feedback cycles and were then circulated via online survey to assess the level of agreement.The pre-defined ratification threshold of 80 % agreement was reached for all statements in the areas of multidisciplinary treatment (n = 4), intra-arterial therapy (n = 14), biologics (n = 5), radiation therapy (n = 3), surgical resection and transplantation (n = 7), and percutaneous ablative therapy (n = 4). These generally reflected an expansion in treatment options due to developments in previously established or emergent techniques, introduction of new and more active therapies and increased therapeutic flexibility. These developments have allowed for greater treatment tailoring and personalization as well as a paradigm shift toward strategies with curative intent in a wider range of disease settings.Copyright © 2023. Published by Elsevier Ltd.