Martinotti R, Evangelista W, Goss M, Angelini F, Satolli M A
UODU Chirurgia Oncologica, Day Hospital Oncologico, A.O. S. Giovanni Battista, Torino, Italy.
Minerva Med. 2001 Oct;92(5):341-7.
Hepatocellular carcinoma (HCC) is the fourth cause of death for cancer, the first in northern Africa and is the eighth tumor for incidence in the world. Risk factors are: liver cirrhosis, HBV, HCV and natural toxins (i.e. aflatoxin). A screening program is feasible and based on serum alpha-fetoprotein dosage and periodic liver ultrasonography. Instrumental diagnosis is based on ultrasonography associated with angiography or spiral TC associated with systemic portography. The best therapy of HCC is based on a multimodal approach: surgery when feasible, associated with or in alternative to intratumoral ethanol injection (PEI), transcatheter arterial chemoembolization (TACE), chemotherapy and radiotherapy. These different therapeutical approaches are related to the liver extent of the disease and liver functioning. Poor results obtained with chemotherapy led to research different therapeutical approaches as hormonal substances, immune modulators or genetic modulators. Most patients present with advanced disease, and their survival rate decreases with the increase of liver cirrhosis concomitant with HCC. Better results should be obtained with the use of different therapeutical approaches as angiogenetic inhibitors, today only for experimental use at present.
肝细胞癌（HCC）是癌症死亡的第四大原因，在北非位列第一，是全球第八大常见肿瘤。危险因素包括：肝硬化、乙肝病毒（HBV）、丙肝病毒（HCV）和天然毒素（如黄曲霉毒素）。筛查方案可行，基于血清甲胎蛋白检测和定期肝脏超声检查。仪器诊断基于超声检查结合血管造影，或螺旋CT结合全身门静脉造影。HCC的最佳治疗基于多模式方法：可行时进行手术，可联合或替代瘤内乙醇注射（PEI）、经动脉化疗栓塞（TACE）、化疗和放疗。这些不同的治疗方法与疾病在肝脏的范围和肝功能有关。化疗效果不佳促使人们研究不同的治疗方法，如激素类物质、免疫调节剂或基因调节剂。大多数患者就诊时已处于疾病晚期，其生存率随着与HCC同时出现的肝硬化的加重而降低。使用不同的治疗方法，如血管生成抑制剂，有望取得更好的效果，目前血管生成抑制剂仅用于实验。
