Maria Sofia, Gaetano La Greca, Rosanna Portale Teresa, Rosario Lombardo, Elisa Minona, Antonietta Trovato Maria, Domenico Russello, Stefano Puleo
Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Catania, Italy.
Hepatogastroenterology. 2009 Jul-Aug;56(93):1090-4.
BACKGROUND/AIMS: The Barcelona Clinic Liver Cancer (BCLC) classification has been recently validated as the best system for treatment guidance for hepatocellular carcinoma (HCC), but it doesn't properly consider liver dysfunction. The aim of this retrospective study is to evaluate the usefulness of BCLC for hepatic surgeons comparing our treatment decision and BCLC algorithm indications.
A retrospective analysis of 102 patients affected by HCC observed from 1991 to 2002 was performed. The treatment choice was compared with the treatment schedule proposed by BCLC.
Of 102 patients, in 44 (43.1%) cases, the present study treatment and BCLC system agreed, while in the remnant 58 (56.9%) cases, there was an under treatment in 47 (81.1%) patients and an overtreatment in 11 (18.9%). About the undertreatment cases we didn't perform hepatic resection such as BCLC suggests because of advanced age and/or high level of IGC; in patients in whom BCLC would suggest chemoembolization, we supposed this treatment as high risk therapy. Regarding the overtreatment, we choose hepatic resection, because early Child B class and good liver functional status.
Analysing our aprroach in the treatment of HCC during ten years before introduction of BCLC classification, we can conclude that even if our treatment choice disagreed with BCLC systems, this wouldn't changed our decision especially in surgical indications.
背景/目的：巴塞罗那临床肝癌（BCLC）分期系统最近被确认为肝细胞癌（HCC）治疗指导的最佳系统，但它未充分考虑肝功能障碍。这项回顾性研究的目的是通过比较我们的治疗决策和BCLC算法指征，评估BCLC分期系统对肝脏外科医生的实用性。
对1991年至2002年间观察到的102例HCC患者进行回顾性分析。将治疗选择与BCLC分期系统提出的治疗方案进行比较。
102例患者中，44例（43.1%）本研究的治疗方案与BCLC分期系统一致，而其余58例（56.9%）中，47例（81.1%）治疗不足，11例（18.9%）治疗过度。关于治疗不足的病例，由于患者年龄较大和/或国际标准化比值（IGC）水平较高，我们未按照BCLC分期系统的建议进行肝切除术；对于BCLC分期系统建议进行化疗栓塞的患者，我们认为这种治疗是高风险治疗。关于治疗过度的病例，由于患者处于Child B级早期且肝功能状态良好，我们选择了肝切除术。
分析在引入BCLC分期系统之前的十年中我们对HCC的治疗方法，我们可以得出结论，即使我们的治疗选择与BCLC分期系统不一致，这也不会改变我们的决策，尤其是在手术指征方面。
