At the recent 14th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2024), Dr. Jian Zhou from Zhongshan Hospital, Fudan University, officially assumed the position of the new Chairman of the Asia-Pacific Primary Liver Cancer Expert Association (APPLE). This marks the first time since the establishment of the APPLE Alliance that a Chinese mainland expert has held the chairmanship, signifying that Chinese liver cancer experts will step onto this highly influential international academic stage as leaders. This allows for deeper integration of Chinese wisdom and strength into international liver cancer academic exchanges. Oncology Frontier and Hepatology Digest had the privilege of interviewing Dr. Jian Zhou to share his thoughts and plans as the new APPLE Chairman, the significant achievements in the field of liver cancer surgical treatment in China, and the growing international influence of Chinese liver cancer guidelines and consensus, which have greatly promoted standardized diagnosis and treatment of liver cancer.Oncology Frontier: Congratulations on being elected Chairman of the Asia-Pacific Primary Liver Cancer Expert Association. What kind of academic organization is APPLE? What are your thoughts on being elected Chairman?
Dr. Jian Zhou: The Asia-Pacific Primary Liver Cancer Expert Association (APPLE), with its official journal “Liver Cancer,” started as the Asia-Pacific Primary Liver Cancer Expert Meeting in 2010 in Korea, involving experts from China, Japan, Korea, and Western countries. In 2013, experts from China, Japan, and Korea officially established the APPLE Alliance. Over the past decade, APPLE has developed into a leading international academic organization for primary liver cancer. Its main goals are to improve the scientific management of liver cancer diagnosis and treatment, promote information exchange in the field, and achieve more consensus in liver cancer diagnosis and treatment through academic exchanges in clinical practice and scientific research.
The APPLE conference has been held 13 times. This year’s 14th APPLE conference was held in Hawaii, USA, chaired by Professor Ghassan Abou-Alfa from Memorial Sloan Kettering Cancer Center and Professor Linda L. Wong from the University of Hawaii Cancer Center. While attendees primarily come from the Asia-Pacific region, the conference also attracts experts from around the world, showcasing APPLE’s growing global academic influence.
I am honored to have been appointed as the new Chairman of APPLE at this conference, the first time a scholar from mainland China has held this position. This appointment is not only a recognition of my work but also an acknowledgment of the research achievements and increasing academic influence of many Chinese liver cancer scholars on the international stage.
Oncology Frontier: At this year’s APPLE conference, you introduced the international colleagues to Chinese liver cancer treatment guidelines and original research achievements. What significant accomplishments have Chinese scholars made in liver cancer surgery that have attracted international attention?
Dr. Jian Zhou: “Standing on the shoulders of giants” is the foundation of our innovation. Pioneers like Academicians Tang Zhaozhou, Wu Mengchao, and Qiu Fazu laid a solid foundation for liver cancer surgery in China. In recent years, colleagues in the field have been innovative, performing many “world first” or “Asia first” surgeries, with some techniques reaching international leading levels.
Under the personal guidance of Academician Fan Jia, our liver tumor surgery team at Zhongshan Hospital, Fudan University, performs over 7,000 surgeries annually, making it the largest single-center liver cancer surgery center in the world, with patient survival rates at international leading levels. We have performed the world’s first “dual liver transplant” using a relative’s liver and a discarded liver, the world’s first “discarded liver” transplant combined with ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy) for advanced liver cancer, and the first ALPPS surgery in Asia. Over the years, we have expanded the application range of ALPPS, giving many patients with initially unresectable large or multiple liver cancers the hope of radical resection and long-term survival. Our team has completed the largest number of ALPPS surgeries internationally, with postoperative survival rates also leading globally.
Oncology Frontier: At this conference, you also introduced the “Chinese Primary Liver Cancer Diagnosis and Treatment Guidelines” (CNLC Guidelines) to international colleagues. What important achievements has China made in promoting standardized diagnosis and treatment of liver cancer?
Dr. Jian Zhou: As I emphasized at the APPLE conference, we need “Chinese guidelines.” Firstly, Chinese liver cancer patients may differ from those in other countries. Most Chinese liver cancer patients have hepatitis B virus (HBV)-related liver cancer, and non-alcoholic steatohepatitis (NASH)-related liver cancer is also increasing. Moreover, nearly 70% of Chinese liver cancer patients are diagnosed at an advanced stage, indicating significant heterogeneity in liver cancer in China compared to other regions.
Secondly, the current state of liver cancer diagnosis and treatment in China differs from that in other countries, including medical insurance policies and drug accessibility, safety, and efficacy. Chinese liver cancer patients are distinct in many ways.
Thirdly, China has been rapidly introducing international new drugs (such as lenvatinib and immune checkpoint inhibitors like atezolizumab, pembrolizumab, and durvalumab), and domestic innovative drugs (such as camrelizumab, toripalimab, tislelizumab, sintilimab, cadonilimab, and new TKIs like apatinib and donafenib) have also developed quickly, benefiting liver cancer patients in China and worldwide.
Therefore, we hope to create CNLC guidelines with Chinese characteristics and an international perspective to provide scientific and clear practice guidance for standardized diagnosis and treatment of liver cancer in China. The CNLC guidelines have been updated to integrate new domestic and international evidence, forming a clear CNLC staging and treatment path, which is more suitable for Chinese liver cancer patients compared to the Barcelona Clinic Liver Cancer (BCLC) staging system.
In addition to the CNLC guidelines, there are many “Chinese norms and standards,” such as the “Chinese Expert Consensus on Conversion and Perioperative Treatment of Primary Liver Cancer” published in 2024, which adopts numerous advances in clinical medical evidence from China to form guidelines focused on conversion and perioperative treatment of liver cancer. The “Chinese Expert Consensus on Adjuvant Treatment of Liver Cancer After Surgery” published in 2023 was written based on domestic and international expert experience and the results of the “Postoperative Adjuvant Treatment of Liver Cancer Status Survey” project, providing comprehensive guidance for clinical doctors on adjuvant treatment after liver cancer surgery.
The English versions and guideline interpretation articles of the updated CNLC guidelines have been published in international journals such as “Liver Cancer” and “Hepatobiliary Surgery and Nutrition,” gradually gaining more attention and recognition from domestic and international colleagues. The main reason is that our guidelines combine national conditions with the latest evidence-based medical evidence, practically guiding our liver cancer diagnosis and treatment practice, effectively improving patient survival rates. Improving patient survival is the “hard truth” and the ultimate goal we as doctors always pursue.
Dr. Jian Zhou Member of the Academic Division of the Chinese Academy of Medical Sciences Executive Vice President of Zhongshan Hospital, Fudan University President of Xuhui District Central Hospital, Shanghai Executive Deputy Director of the Liver Cancer Institute, Fudan University Recipient of the National Science Fund for Distinguished Young Scholars, Yangtze River Scholar Distinguished Professor Leading Talent in Scientific and Technological Innovation under the National “Ten Thousand Talents Plan,” Shanghai Scientific Elite Executive Director of the Expert Committee on “Primary Liver Cancer Diagnosis and Treatment Standards/Guidelines” of the National Health Commission Chairman of the Asia-Pacific Primary Liver Cancer Expert Association (APPLE) Chairman-elect of the Oncology Branch of the Chinese Medical Association Vice President and Secretary-General of the Surgeons Branch of the Chinese Medical Doctor Association Deputy Director of the Transplant Immunology Branch of the Chinese Society of Immunology Vice Chairman of the General Surgery Professional Committee of the Chinese Research Hospital Association Deputy Director of the Liver Cancer Quality Control Expert Committee of the National Cancer Center’s National Tumor Quality Control Center Immediate Past Chairman of the Tumor Specialist Branch of the Shanghai Medical Association Immediate Past Chairman of the Liver Cancer Professional Committee of the Chinese Anti-Cancer Association Executive Director of the Asia-Pacific Association for the Study of the Liver (APASL) Chairman-elect of the Organ Transplantation Specialist Branch of the Shanghai Medical Association Recipient of five National Science and Technology Progress Awards (including once as the first contributor and twice as the second contributor) Published 129 SCI papers as the first or corresponding author (including co-authorship), with an H-index of 79
