Evidence and Consensus on the Management of Hepatocellular Carcinoma: Update 2015

display demonstrates utility in increasing operator comprehension of spatial and positional relationships during percutaneous US examination. Kariyama et al. [8] evaluated the efficacy and safety of radiofrequency ablation [9–11] in treating intermediatestage hepatocellular carcinoma (HCC). Intermediatestage HCCs are a very heterogeneous disease. Therefore, several proposals for the subclassification of this stage have been made, such as the subclassifications by Bolondi et al. [12] and Yamakado et al. [13] as well as the Kinki criteria by Kudo et al. [14] . The Kinki criteria recommend that the substage B1 (Child-Pugh score 5, 6 or 7, and a tumor status beyond the Milan and ‘up to 7’ criteria) should be treated by curative treatment option, such as resection or ablation, when the tumor status is relatively limited. Kariyama et al. [8] clearly supported our proposal and stated that even intermediate-stage HCCs can be successfully treated by radiofrequency ablation, with a 5-year survival rate of 80% in patients with multicentric intermediate-stage HCCs. Minami et al. [15] investigated whether balloon-occluded TACE (b-TACE) can produce a more dense accumulation of iodized oil in various stages of HCC, from single to multiple tumors, to overcome poor local control. They found that b-TACE is effective in the retreatment of HCC, with an insufficient outcome from conventional TACE, but it could not improve the efficacy of treatment for multiple bilobar HCCs. Tochio et al. [16] stated that the hyperenhanced rim (HER) sign in the postvascular phase of sonazoid-enThe 1st Asia-Pacific Primary Liver Cancer Expert (APPLE) meeting was held in Seoul in 2010, followed by the 2nd APPLE meeting in Osaka, the 3rd APPLE meeting in Shanghai, the 4th APPLE meeting in Busan, and the 5th APPLE meeting in Taipei. All of these were extremely successful. The 6th APPLE meeting was held on July 3–5, 2015, in Osaka, Japan. At this meeting, 118 renowned international and national speakers were invited ( table 1 ), and more than 600 participants from Asia and other parts of the world participated. Highly scientific lectures followed by active discussion made this meeting invaluable. In this supplement issue, some of the presented papers are included. Arizumi et al. [1] stated that the Assessment for Retreatment with Transarterial Chemoembolization (TACE) [2–4] (ART) scoring system, which was proposed by Sieghart et al. [5] , did not demonstrate a sufficiently predictive impact on overall survival among patients who underwent a 2nd TACE session within 90 days [6] . Also, they stated that the application of the ART score should be carefully considered because differences in TACE procedures and post-TACE treatment can affect the results while evaluating overall survival. Ogawa et al. [7] reported the efficacy of percutaneous ultrasound (US) examination using a novel, real-time virtual sonography method that collates multiple Digital Imaging and Communications in Medicine (DICOM) data sources and displays reference images in color. They concluded that real-time virtual sonography with color Published online: November 19, 2015