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肝细胞癌的治疗

Treatment of hepatocellular carcinoma.

作者信息

Forner Alejandro, Hessheimer Amelia J, Isabel Real M, Bruix Jordi

机构信息

Liver Unit, Institut de Malalties Digestives i Metaboliques, BCLC Group, IDIPAPS, Hospital Clinic, University of Barcelona, c/Villarroel 170, E-08036 Barcelona, Spain.

出版信息

Crit Rev Oncol Hematol. 2006 Nov;60(2):89-98. doi: 10.1016/j.critrevonc.2006.06.001. Epub 2006 Jul 24.

Abstract

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third cause of cancer-related death. Despite therapeutic advances, the overall survival of patients with HCC has not significantly improved in the last two decades. In the majority of the cases there is underlying cirrhosis, so the prognosis of HCC depends on not only tumor stage but also liver function. There is not a widely accepted HCC staging system. In our group we have developed a new staging classification that stratifies HCC patients into four major categories and simultaneously links staging with treatment. Patients at an early stage are those who present with an asymptomatic single HCC with a maximum diameter of 5cm or up to three nodules each less than 3cm. They will benefit from curative therapies, including resection, liver transplantation (LT), and percutaneous ablation. Patients exceeding these limits, but who are free of cancer-related symptoms and vascular invasion or extrahepatic spread fit into the intermediate stage and may benefit from palliation with chemoembolization. The patients with mild cancer-related symptoms and/or vascular invasion or extrahepatic spread are included in the advanced stage. In this stage there is not effective therapy, and these patients may profit from new therapies in the setting of randomized controlled trials (RCTs). Finally, the patients with severe cancer-related symptoms or great tumor burden belong to the terminal stage and only benefit from symptomatic treatment.

摘要

肝细胞癌(HCC)是全球第五大常见癌症,也是癌症相关死亡的第三大原因。尽管治疗取得了进展,但在过去二十年中,HCC患者的总体生存率并未显著提高。在大多数情况下存在潜在的肝硬化,因此HCC的预后不仅取决于肿瘤分期,还取决于肝功能。目前尚无广泛接受的HCC分期系统。我们团队开发了一种新的分期分类方法,将HCC患者分为四大类,并同时将分期与治疗联系起来。早期患者是指那些表现为无症状的单个HCC,最大直径为5cm或最多三个每个直径小于3cm的结节的患者。他们将从根治性治疗中获益,包括切除、肝移植(LT)和经皮消融。超过这些限度,但无癌症相关症状、血管侵犯或肝外转移的患者属于中期,可能从化疗栓塞的姑息治疗中获益。有轻度癌症相关症状和/或血管侵犯或肝外转移的患者属于晚期。在这个阶段没有有效的治疗方法,这些患者可能会从随机对照试验(RCT)中的新疗法中获益。最后,有严重癌症相关症状或肿瘤负荷较大的患者属于终末期,仅从对症治疗中获益。

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