Llovet Josep M, Schwartz Myron, Mazzaferro Vincenzo
BCLC Group, Liver Unit, Digestive Disease Institute, IDIBAPS, Hospital Clínic, University of Barcelona, Catalonia, Spain.
Semin Liver Dis. 2005;25(2):181-200. doi: 10.1055/s-2005-871198.
Surveillance programs in cirrhotic patients enable the detection of hepatocellular carcinoma (HCC) at early stages, when the tumor is amenable to curative treatments (60% of cases in Japan; 25 to 40% in Europe and the United States). Resection is the mainstay of treatment in noncirrhotic patients and in cirrhotics with well-preserved liver function. In modern series, a perioperative mortality < or = 3% and 5-year survival rates above 50% are expected. Tumor recurrence complicates half of the cases at 3 years, but there is no unquestionable preventive treatment. Liver transplantation provides excellent outcomes applying the Milan criteria (single nodule < or = 5 cm or two or three nodules < or = 3 cm), with 5-year survival rates of 70% and low recurrence rates. Although expansion of selection criteria is appealing, it should be assessed in the setting of prospective well-designed studies. Intention-to-treat analysis has shown that wide extended indications lead to 25% 5-year survival rates. Living donor liver transplantation is having a minor impact in HCC management. Molecular markers are needed to better select the candidates for surgery.
对肝硬化患者的监测计划能够在肝细胞癌（HCC）的早期阶段检测到肿瘤，此时肿瘤适合进行根治性治疗（在日本60%的病例适用；在欧洲和美国为25%至40%）。肝切除术是无肝硬化患者以及肝功能良好的肝硬化患者的主要治疗方法。在现代系列研究中，围手术期死亡率≤3%，预期5年生存率超过50%。3年时，肿瘤复发使一半的病例病情复杂化，但尚无确凿的预防治疗方法。应用米兰标准（单个结节≤5 cm或两到三个结节≤3 cm）进行肝移植可取得良好效果，5年生存率为70%，复发率低。尽管扩大选择标准很有吸引力，但应在前瞻性精心设计的研究背景下进行评估。意向性分析表明，广泛扩大适应症会导致5年生存率为25%。活体供肝肝移植对HCC治疗的影响较小。需要分子标志物来更好地筛选手术候选人。
