Massachusetts General Hospital, GI Unit, Boston, MA, USA.
Therap Adv Gastroenterol. 2009 Jan;2(1):45-57. doi: 10.1177/1756283X08100328.
The incidence of hepatocellular carcinoma (HCC) is increasing worldwide. A multi-disciplinary approach is required for its management. Screening high-risk patients allows for earlier diagnosis and the use of potentially curative therapies. Current recommendations for HCC screening for patients with cirrhosis are an abdominal ultrasound and serum alpha fetoprotein level every 6 to 12 months. Treatment choice depends on tumor stage, liver function and the patient's overall functional status. Curative therapies include surgical resection, liver transplantation (LT), transarterial chemoembolization, and radiofrequency ablation (RFA). Surgical resection, either primary resection or LT, is the treatment most likely to result in cure of HCC. Which option to pursue is based on multiple factors. LT has the potential benefit of treating both HCC and the underlying cirrhosis; however, long wait times incur the risk of tumor progression. Firm recommendations regarding the role of living donor LT for HCC are not yet possible because of conflicting data. HCC recurrence after LT is 8-11% and several adjuvant therapies have been investigated to reduce this. Bridging therapy and tumor downsizing are techniques that also may be considered to deal with long waiting periods and qualification for LT, respectively. If neither LT nor primary resection is possible, loco-regional therapies such as RFA and TACE should be considered. Systemic chemotherapies have proved disappointing for the treatment of HCC; however, newer targeted therapies such as sorafenib and cetuximab have provided new hope for the future.
肝细胞癌 (HCC) 的发病率在全球范围内呈上升趋势。需要多学科方法来管理。对高危患者进行筛查可以实现更早的诊断和潜在的治愈性治疗。目前建议对肝硬化患者进行 HCC 筛查，方法是每 6-12 个月进行一次腹部超声和血清甲胎蛋白水平检测。治疗选择取决于肿瘤分期、肝功能和患者的整体功能状态。治愈性治疗包括手术切除、肝移植 (LT)、经动脉化疗栓塞和射频消融 (RFA)。手术切除，无论是原发性切除还是 LT，是最有可能治愈 HCC 的治疗方法。选择哪种方法取决于多种因素。LT 具有治疗 HCC 和潜在肝硬化的潜在益处；然而，长时间等待会增加肿瘤进展的风险。由于数据相互矛盾，目前尚不能对活体供者 LT 治疗 HCC 的作用提出明确建议。LT 后 HCC 复发率为 8-11%，已经研究了几种辅助治疗方法来降低这种风险。桥接治疗和肿瘤缩小术是两种技术，分别可用于应对长时间等待和 LT 资格问题。如果 LT 或原发性切除术均不可行，则应考虑使用局部区域治疗方法，如 RFA 和 TACE。全身化疗在 HCC 治疗中效果不佳；然而，索拉非尼和西妥昔单抗等新型靶向治疗方法为未来带来了新的希望。
