Park Joong Won
Korean Liver Cancer Study Group, Korea.
Korean J Hepatol. 2004 Jun;10(2):88-98.
BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is the 3rd most common cancer. The annual incidence is over 10,000 cases in Korea. While hepatitis B virus is major cause of Korean HCC, the impact of alcoholic liver disease is a rising trend. The 5-year survival rate of HCC is only 9.6%, mainly due late diagnosis, tumor biology and underlying chronic liver diseases. Because almost eighty percent of HCC is diagnosed in late, not early stages, a nationwide surveillance program to screen high risk groups (HBV or HCV carriers or liver cirrhosis, over 40 years old) was launched last year and a practice guideline, with special emphasis on advanced stage HCC was formulated.
Forty-five experts from KLCSG and the National Cancer Center participated in a special committee to develop a practice guideline for HCC. Based on scientific evidence, the consensus was made for diagnosis and treatment strategy after considering the medico-social situation in Korea.
Required and optional tests and clinical (non-invasive) diagnosis criteria for HCC are identified. The first decision, based on both Child-Pugh score and modified UICC tumor staging, is to determine operability. The second decision, to determine resectability, is based on localization of the tumor and residual liver function. Chemoembolization or local ablation therapy is allowed for resectable tumors in certain conditions, such as at borderline risk or non-invasively diagnosed. Unresectable tumors are classified into either a group with inadequate residual liver functions or the another group with extensive or macrovascular invasion or distant metastases. Indications of liver transplantation, chemoembolization, local ablation, radiation therapy and chemotherapy for unresectable HCC are presented.
This guideline is expected to be useful for clinical management of, and research for HCC patients.
背景/目的：肝细胞癌（HCC）是第三大常见癌症。在韩国，其年发病率超过10000例。虽然乙肝病毒是韩国HCC的主要病因，但酒精性肝病的影响呈上升趋势。HCC的5年生存率仅为9.6%，主要原因是诊断延迟、肿瘤生物学特性以及潜在的慢性肝病。由于几乎80%的HCC是在晚期而非早期被诊断出来的，去年启动了一项全国性监测计划，以筛查高危人群（乙肝或丙肝携带者、肝硬化患者，年龄超过40岁），并制定了一项特别强调晚期HCC的实践指南。
来自韩国肝脏研究学会（KLCSG）和国家癌症中心的45名专家参与了一个特别委员会，以制定HCC的实践指南。基于科学证据，在考虑韩国的医疗社会状况后，就诊断和治疗策略达成了共识。
确定了HCC所需和可选的检查以及临床（非侵入性）诊断标准。第一个决策基于Child-Pugh评分和改良的国际抗癌联盟（UICC）肿瘤分期，以确定手术可行性。第二个决策是确定可切除性，基于肿瘤的定位和残余肝功能。在某些情况下，如处于临界风险或经非侵入性诊断的可切除肿瘤，允许进行化疗栓塞或局部消融治疗。不可切除的肿瘤分为两组，一组是残余肝功能不足，另一组是有广泛或大血管侵犯或远处转移。给出了不可切除HCC的肝移植、化疗栓塞、局部消融、放射治疗和化疗的适应证。
本指南预计将有助于HCC患者的临床管理和研究。
