不能手术切除的晚期肝癌患者的全身疗法已有惊人的进展，改善了患者的平均预后。因此，肝癌治疗准则也发生了显著变化。然而，在临床实践中出现了各种问题。首先，目前尚无已确立的生物标志物可预测全身药物治疗的反应。其次，原发性全身治疗（包括联合免疫疗法）后尚无已确立的治疗方案。第三，中间期肝癌尚无已确立的治疗方案。这些因素使当前指南不明确。本综述介绍了基于最新证据的日本肝癌诊断和治疗指南；介绍了主要针对日本实际生活实践的各种努力，以更新这些指南；并提出了我们对未来指南的看法。

Striking advances in systemic therapy for unresectable advanced hepatocellular carcinoma (HCC) have improved the average prognosis of patients with HCC. As a result, the guidelines for the treatment of HCC have changed significantly. However, various issues have emerged in clinical practice. First, there is no established biomarker that can predict response to systemic drug therapy. Second, there is no established treatment regimen after primary systemic therapy, including combined immunotherapy. Third, there is no established treatment regimen for intermediate-stage HCC. These points make the current guidelines ambiguous. In this review, we present the Japanese guidelines for the diagnosis and treatment of HCC based on the latest evidence; introduce various efforts mainly in Japanese real-life practice to update these guidelines; and present our perspectives on future guidelines.