Hong Kong's CU Medicine Ranked World No. 2 in Gastroenterology & Hepatology — And Led The Lancet's First-Ever Liver Cancer Commission

HONG KONG — The Chinese University of Hong Kong (CUHK) Faculty of Medicine has been ranked World No. 2 in Gastroenterology and Hepatology in the 2026-27 edition of the U.S. News & World Report Best Global Universities subject rankings, released in late June 2026 — the fourth consecutive edition in which the faculty has held a position in the global top three. The same release confirmed CUHK at No. 1 in Asia for Gastroenterology and Hepatology, Endocrinology and Metabolism, and Clinical Medicine, and at No. 1 in Hong Kong for seven of its eight core disciplines. But the ranking is the smaller of the two stories in the release. The larger one is the 51-expert international commission on liver cancer that CUHK scholars led, the first major cancer report in The Lancet's 200-year history to be spearheaded by Hong Kong researchers, published in 2025 and continuing to drive international clinical guidelines in 2026.

For international patients with hepatocellular carcinoma (HCC), cholangiocarcinoma, or other primary liver cancers — especially those whose home country lacks the surgical volume, the transplant infrastructure, or the combination of locoregional and systemic therapies available in East Asia — CUHK's Prince of Wales Hospital and the affiliated Hong Kong Liver Cancer Registry sit at the center of a clinical pipeline that is hard to assemble outside a handful of centers globally. The pipeline runs from early detection (CUHK's stool-microRNA colorectal screening test is the world's first, and the same group has been working on parallel non-invasive blood-based markers for hepatocellular carcinoma) through to curative-intent therapy (CUHK's own publications include some of the largest series in the world of combination transarterial chemoembolization plus systemic therapy for intermediate-stage HCC) and on to the long-term follow-up that distinguishes a high-volume liver cancer center from a general oncology service. The Lancet commission, published across 2024 and 2025 with the full report in late 2025, formalized the evidence base for the pathway that CUHK and a small set of peer institutions have been building for two decades.

No other major hepatology center sits at exactly this intersection. The Mayo Clinic in Rochester, Minnesota, the King's College Hospital liver program in London, and the MD Anderson Cancer Center in Houston each have strengths in different parts of the pipeline — transplant volume, viral hepatitis management, or systemic therapy for advanced disease — but the CUHK combination of high-volume early detection, the world's first endoluminal robotics program for GI cancer, the first AI-powered upper-GI endoscopy platform, and a Lancet-level role in shaping the global research agenda, is a stack that is difficult to match. The Lancet commission, in particular, matters for international patients because it is the document that the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), and the Asian Pacific Association for the Study of the Liver (APASL) are now aligning their clinical guidelines against — meaning the same evidence base that is being used in Hong Kong is being used to write the rules for liver cancer care in Europe, North America, and the rest of Asia.

What the Lancet Commission on Liver Cancer does, in practice

The Lancet Commission on Liver Cancer is the most ambitious attempt to date to write a single, integrated, evidence-based plan for the prevention, early detection, treatment, and survivorship of primary liver cancer — hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and the rarer fibrolamellar and combined hepatocellular-cholangiocarcinoma subtypes. Published in multiple Lancet-family papers in 2024 and 2025, with the integrated commission report in late 2025, the document is the work of 51 authors from the United States, Europe, mainland China, Hong Kong, Japan, Korea, Singapore, Australia, and a handful of low- and middle-income countries where liver cancer is endemic. The commission is co-chaired by Hong Kong-based hepatologists, with five CUHK scholars on the author list including one as first author of a key section. The fact that the journal's first major cancer commission in two centuries is led from Hong Kong is, by itself, a measure of how central the city has become to the global liver cancer conversation.

What the commission does, in practice, is build an evidence chain that links the upstream causes of liver cancer — chronic hepatitis B (the dominant cause in East Asia and Sub-Saharan Africa), chronic hepatitis C (the dominant cause in Europe, Japan, and North America), metabolic dysfunction-associated steatotic liver disease / MASLD (the fastest-growing cause globally, including in China), aflatoxin exposure (still relevant in parts of Sub-Saharan Africa and rural China), and alcohol-related liver disease — to a downstream treatment pathway that is stratified by stage, liver function, performance status, and the molecular subtype of the tumor. For each link in the chain, the commission reviews the evidence, identifies where the evidence is strong enough to support a guideline-grade recommendation, and flags the gaps where further research is needed. The result is the kind of document that a hepatologist in any country can use to argue with a payer, a hospital administrator, or a colleague about what a liver cancer patient should receive — and increasingly, it is the document that guidelines bodies themselves are working from.

The commission's most consequential practical contribution is its treatment-stage framework. The traditional Barcelona Clinic Liver Cancer (BCLC) staging system, in use since 1999, sorts patients into five stages (0, A, B, C, D) and assigns a single recommended treatment to each stage — a simplicity that has helped the system become the global standard but that has also been criticized for being too rigid in an era of combination therapy. The Lancet commission does not replace BCLC, but it overlays a more granular framework that recognizes the role of combination locoregional plus systemic therapy for intermediate-stage disease, the role of immunotherapy-based combinations for advanced disease (the atezolizumab-bevacizumab combination, the tremelimumab-durvalumab combination, and the more recent camrelizumab-rivoceranib combination have all reported positive Phase 3 data in 2024 and 2025), and the role of liver transplantation as a curative option for selected patients with cirrhosis who would otherwise face a recurrence rate of 70 percent or higher after resection. For an international patient, the practical upshot is that the same combination therapy they might be told is "not yet standard" at a smaller center is, in many cases, exactly what the commission framework recommends — and is being delivered at the centers that wrote the framework.

What makes the CUHK pipeline different from a typical Western hepatology center

The combination of programs at CUHK is the part that does not have a direct parallel outside East Asia. The faculty runs one of the world's largest hepatocellular carcinoma screening programs, with a published cohort of more than 1,000 chronic hepatitis B carriers followed with biannual ultrasound and alpha-fetoprotein for HCC surveillance — the kind of program that produces the long-term outcomes data that guideline writers want to see. The same group has been the world's first to develop a stool-microRNA-and-bacterial-marker test for non-invasive colorectal cancer screening, with the parallel work on blood-based markers for HCC ongoing as of 2026. The faculty's endoscopy unit, led by Professor Philip Chiu (now Dean of Medicine), was the first in the world to perform peroral endoscopic myotomy (POEM) for achalasia in 2010, the first to develop endoluminal robotics for GI cancer, and the first to deploy an AI-augmented upper-GI endoscopy platform in routine clinical practice. And the surgical hepatobiliary service at the Prince of Wales Hospital runs one of the highest-volume living-donor liver transplant programs in Asia, with a published experience of more than 1,500 living-donor liver transplants to date.

For a liver cancer patient, the practical sequence inside this pipeline looks roughly like the following. A patient with chronic hepatitis B, cirrhosis, and a 2-centimeter lesion found on surveillance ultrasound enters the Prince of Wales Hospital system. The lesion is characterized by contrast-enhanced MRI and a hepatocyte-specific contrast agent (gadoxetic acid), and a biopsy is taken for molecular subtyping if the imaging is ambiguous. If the lesion is confirmed as early-stage HCC and the patient's liver function is preserved (Child-Pugh A, MELD under 10), the patient is offered surgical resection or, depending on tumor size and location, radiofrequency ablation as a curative-intent option. If the patient is transplant-eligible and meets the expanded criteria for living-donor liver transplant (the CUHK program, like most East Asian programs, uses criteria that are broader than the Milan criteria used in many Western centers), transplant is discussed. If the disease is intermediate-stage (BCLC B), the patient is offered combination therapy — transarterial chemoembolization (TACE) plus a systemic agent, most commonly a tyrosine kinase inhibitor or an immune checkpoint inhibitor, with the regimen aligned to the latest version of the commission framework. If the disease is advanced (BCLC C), the patient receives atezolizumab-bevacizumab (the most commonly used first-line combination as of 2026), with second-line options including tremelimumab-durvalumab or camrelizumab-rivoceranib depending on prior response and the patient's tolerance of bevacizumab. Throughout, the patient is enrolled in a registry that feeds the long-term outcomes database that the commission and the global hepatology community rely on.

The cost of moving through this pipeline as an international patient varies, but the order of magnitude is well below U.S. pricing. A curative-intent liver resection for HCC at a Hong Kong teaching hospital, with a seven-day inpatient stay and standard pre- and post-operative imaging, runs in the range of HK$200,000 to HK$350,000 (roughly US$25,500 to US$45,000) as of mid-2026 — about a third of the typical U.S. academic medical center charge for the same procedure, and roughly half the cost at a top private hospital in Singapore. Living-donor liver transplant, which is the most expensive single procedure in the pipeline, runs in the range of HK$1,000,000 to HK$1,500,000 (roughly US$128,000 to US$192,000) all-in for the recipient, with the donor's workup and surgery typically covered as a separate but lower-cost item. Systemic therapy with atezolizumab-bevacizumab runs roughly HK$40,000 to HK$60,000 per cycle (US$5,100 to US$7,700), with cycles every three weeks until progression. The combination of cost and clinical pipeline is what has put Hong Kong on the medical-tourism map for liver cancer specifically — the same combination that has put the city on the map for solid-tumor CAR-T (covered in the 2026-06-23 piece on satri-cel at the parallel Mainland center) and robotic microsurgery (covered in the 2026-06-29 HKUMed piece on the world's first robotic living-donor liver transplant).

The endoluminal robotics first — what it is and why it matters for liver cancer staging

Endoluminal robotics is the part of the CUHK story that sounds most futuristic but is, in fact, already in routine clinical use. The platform, developed in collaboration with a Hong Kong-based medical device company, is a flexible robotic system that can be inserted through a natural orifice — the mouth for upper-GI work, the anus for lower-GI work — and can perform surgical maneuvers (tissue dissection, hemostasis, suturing) inside the lumen of the GI tract with a level of precision that standard flexible endoscopy cannot match. CUHK was the first institution in the world to deploy the platform for the treatment of GI cancers, and the case series published in 2024 and 2025 includes more than 200 patients with early gastric cancer, early esophageal cancer, and complex colorectal polyps treated with endoluminal robotic submucosal dissection — a procedure that, in the pre-robotic era, required either open surgery or a highly skilled endoscopist performing the same procedure with a manual flexible scope over a 60-to-90-minute case.

The liver cancer relevance of the endoluminal robotics program is indirect but real. Patients with HCC frequently have concurrent GI lesions — portal hypertensive gastropathy, gastric varices, and a higher-than-baseline rate of gastric and esophageal cancer, especially in the hepatitis B endemic population that makes up the bulk of Hong Kong's HCC cohort. The endoluminal robotics platform allows the staging workup for an HCC patient to include a high-precision examination of the upper and lower GI tract in the same anesthetic episode, with the option to biopsy, mark, or remove any suspicious lesion at the same sitting. For international patients who arrive in Hong Kong with a confirmed or suspected HCC diagnosis and a partial workup from their home country, the ability to complete the GI staging with the world's first endoluminal robotics platform is a small but real advantage over centers that use standard flexible endoscopy for the same workup. The AI-powered upper-GI endoscopy system that CUHK is also the first to deploy adds a second layer of precision to the same procedure — the system uses computer vision to flag suspicious mucosal patterns in real time, with a published sensitivity for early gastric cancer detection that is higher than the standard endoscopist-only baseline.

The endoluminal robotics work is also the most exportable part of the CUHK pipeline. The platform's manufacturer has been working with the NMPA, the U.S. FDA, and the European Notified Body system in parallel, with the first mainland Chinese deployment at a 3A hospital expected in 2026 or 2027. The AI endoscopy system, similarly, is being rolled out to the first batch of non-CUHK centers in Hong Kong's Hospital Authority network as of mid-2026, with the mainland China rollout expected to follow. For a Chinese hospital that wants to match the CUHK endoscopy capability, the licensing and equipment pathway is now in place — a contrast with the surgical and medical hepatology programs, which depend on volume and operator skill and are not as easily transferred.

What the TREM2+ LAM discovery means for liver cancer immunotherapy

The most recent CUHK liver cancer research finding, published in 2025 and continuing to be refined in 2026, is the discovery that a specific subtype of tumor-associated macrophage — TREM2-positive lipid-associated macrophages, or TREM2+ LAMs — has a "clear out, feed in" function that simultaneously clears apoptotic tumor cells (a process called efferocytosis) and, in doing so, releases nutrients that fuel the surviving cancer cells. The finding is mechanistically important because it identifies a specific cell subtype and a specific mechanism by which the tumor microenvironment supports cancer cell survival, and it suggests that a drug that blocks TREM2 (already in early-phase clinical development by at least three pharmaceutical companies) could, in principle, starve the surviving tumor cells while the immune system attacks the bulk of the tumor. The published work is preclinical, but the implications for a Phase 1 trial in HCC patients who have progressed on atezolizumab-bevacizumab are clear, and at least one CUHK-affiliated Phase 1 trial in this population is in planning as of mid-2026.

The clinical relevance of the TREM2+ LAM work, for international patients, is the same as for any preclinical-to-translational pipeline: the discovery is one to three years away from a first-in-human dose-finding study, and five to seven years away from a registration trial in any indication. The discovery is, however, a useful marker of the depth of the CUHK liver cancer research program. A faculty that is publishing on the TREM2+ LAM mechanism in 2025 is a faculty that is more likely to have an active immunotherapy trial open to international patients in 2027, and is more likely to be familiar with the cutting edge of liver cancer immunotherapy than a center that is still working from the 2018-vintage combination-therapy literature. For patients who have already progressed on first-line immunotherapy and are looking for a trial, the depth of the preclinical research program is a reasonable proxy for the quality of the clinical trial menu.

What the Lancet commission means for clinical guidelines in 2026 and 2027

The Lancet Commission on Liver Cancer is now the document that the major hepatology societies are aligning their guidelines against. The American Association for the Study of Liver Diseases (AASLD) published its 2025 HCC guidance update with explicit references to the commission's framework, the European Association for the Study of the Liver (EASL) is in the middle of a guideline refresh that uses the commission's stage-stratified treatment recommendations as a starting point, and the Asian Pacific Association for the Study of the Liver (APASL) has historically been the most receptive to the Hong Kong-led work because of the geographic and epidemiologic proximity. The practical upshot, for a hepatologist anywhere in the world who is treating a liver cancer patient in 2026, is that the recommendations in the commission report are increasingly the same recommendations that come out of the major society guidelines — a convergence that makes the commission the de facto global reference for the field.

For an international patient, the convergence is good news in one sense and bad news in another. The good news is that the same evidence base is being used in Hong Kong, in London, in Boston, in Singapore, in Tokyo, and increasingly in mainland Chinese academic medical centers — so a patient who is told by a Hong Kong hepatologist that combination TACE plus systemic therapy is the right next step is likely to hear the same recommendation from a hepatologist in any major center worldwide. The bad news is that the access gap — the difference between what is recommended and what is actually available in a given country — is widening in some respects, because the recommended combination therapies are increasingly expensive, increasingly complex, and increasingly dependent on a multidisciplinary team that is not available at every hospital. The Hong Kong teaching hospital model, with the hepatologist, the interventional radiologist, the medical oncologist, the liver transplant surgeon, and the palliative care specialist all in the same building and the same weekly tumor board, is the operational template that the commission is implicitly endorsing. For international patients whose home country does not have that template, traveling to a center that does is the practical answer.

How the CUHK pipeline compares to mainland Chinese centers for liver cancer

The mainland Chinese hepatology field is dominated by a small set of high-volume centers that run comparable case volumes to CUHK — the Eastern Hepatobiliary Surgery Hospital in Shanghai (founded by Wu Mengchao, with the largest single-center liver cancer surgery volume in the world), the West China Hospital of Sichuan University in Chengdu, the Zhongshan Hospital affiliated with Fudan University in Shanghai, the Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan, and the Third Affiliated Hospital of Sun Yat-sen University in Guangzhou. Each of these centers has its own combination of strengths: Eastern Hepatobiliary Surgery Hospital is the largest-volume liver cancer surgery center globally, West China has a strong combination-therapy program for advanced HCC, and Zhongshan has a particular strength in the molecular subtyping and translational research pipeline. The 2026-06-30 Order 818 cell and gene therapy framework article covered the regulatory architecture that governs advanced therapeutics in these mainland centers; the Lancet commission is the global evidence base that the same centers are aligning their clinical practice against.

For an international patient choosing between Hong Kong and a mainland Chinese center, the practical differentiators are language (English is the working language in Hong Kong's teaching hospitals; the major mainland academic centers have established international patient services offices with English-speaking coordinators but the day-to-day clinical conversation is in Mandarin), regulatory environment (Hong Kong operates under a separate regulatory framework from the mainland, with the Hospital Authority as the public-system operator and the Department of Health as the regulator; mainland China operates under the National Health Commission and the National Medical Products Administration), and the specific clinical pipeline (CUHK has the endoluminal robotics and the AI endoscopy firsts, Eastern Hepatobiliary has the world's largest surgical volume, and the rest of the mainland centers have their own sub-specialty strengths). For a liver cancer patient specifically, the CUHK combination of the Lancet commission authorship, the endoluminal robotics program, the AI endoscopy program, and the living-donor liver transplant program is unique, and is the reason that a referral from a Hong Kong hepatologist to a mainland Chinese center (or vice versa) is a more common pattern than a referral within either system alone.

What an international patient should ask before traveling to Hong Kong for liver cancer

For a patient considering a Hong Kong teaching hospital for primary liver cancer, the practical questions to ask the international patient services office before booking travel are largely the same as for any cross-border cancer referral, with a few Hong Kong-specific items. The first is the stage and molecular subtype of the tumor — the Hong Kong center will want the most recent imaging, the biopsy report (or a recent surgical pathology report if the patient has already had a resection), the hepatitis B or C viral load if applicable, the Child-Pugh score and the MELD score, and the patient's performance status. The second is the prior treatment history — which lines of systemic therapy, which locoregional therapies, whether the patient has had a liver transplant evaluation, and whether there is a living donor available if transplant is being considered. The third is the insurance or self-pay arrangement — Hong Kong's public Hospital Authority system treats residents at a heavily subsidized rate, but international patients are billed at the private rate, which is the figure cited in the cost section above. The fourth is the language and documentation requirement — a certified English translation of all reports and imaging is required, and a CD or DICOM-compatible download of the imaging is preferred to printed films.

For a patient with a confirmed or suspected HCC who is not yet at a major center, the more useful first step is often a remote second-opinion consultation with a CUHK hepatologist, typically delivered by the Prince of Wales Hospital's international patient services office. The consultation takes the form of a written report based on the submitted records, with a recommendation on whether the patient should travel to Hong Kong for further evaluation, whether the treatment can be delivered closer to home with a Hong Kong-based physician providing the protocol, or whether the case is one that does not require travel at all. For the subset of patients who do travel — typically those who need the combination therapy that is not available in their home country, or those who need a living-donor liver transplant evaluation that their home center cannot provide — the typical length of stay in Hong Kong is two to four weeks for the initial workup and the first cycle of treatment, with subsequent cycles delivered either in Hong Kong or coordinated with a local oncologist closer to home. The cost structure, the clinical pipeline, and the Lancet commission alignment are the three things that justify the trip; the rest is logistics.

For a U.S. or European patient who is looking at a hepatocellular carcinoma diagnosis and has been told by a home hepatologist that the options are limited to systemic therapy with a checkpoint inhibitor combination, the practical first step is to send the imaging and the biopsy report to the Prince of Wales Hospital international patient services office and ask for a written second opinion. The CUHK pipeline — the endoluminal robotics staging, the AI endoscopy workup, the living-donor liver transplant evaluation, and the commission-aligned combination therapy options — is not a substitute for what a home hepatologist can offer, but it is a complement that is hard to match elsewhere. The Lancet commission, written and led from Hong Kong, is now the document that the home hepatologist is following anyway. Getting the treatment from the same source as the guidelines is the practical argument, and the medical-tourism angle is the operational answer to the question of how.