Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
J Gastroenterol Hepatol. 2012 Mar;27(3):452-7. doi: 10.1111/j.1440-1746.2011.07034.x.
Hepatocellular carcinoma (HCC) is an important cancer worldwide. The main curative treatment modality is surgical resection although only a minority of afflicted patients are amendable because of poor liver function reserve or extensive disease at the time of diagnosis. The selection criteria for surgical resection, however, are variable and frequently appear to be center-specific. Further, they are influenced by rapidly evolving data on the outcomes of surgical resection and other emerging modalities of treatment. Recently, two major international practice guidelines on the management of HCC were published at about the same time, namely those of the American Association for the Study of the Liver (AASLD), and of the Asia-Pacific Association for the Study of the Liver (APASL). These two practice guidelines differ significantly in philosophy and practice with regards to surgical resection. In fact, they reflect the two extremes of a spectrum of existing consensus opinions. The AASLD Guidelines have evolved from the guidelines of the Barcelona Clinic for Liver Cancer (BCLC), and are significantly more conservative with regard to surgical resection compared with the APASL Guidelines. The scientific basis for these major differences in criteria with regard to surgical resection for HCC is reviewed here, particularly with regard to the situation in the Asia-Pacific region where HCC is especially common.
肝细胞癌 (HCC) 是一种重要的全球癌症。主要的治疗方法是手术切除，但由于肝功能储备差或诊断时疾病广泛，只有少数受影响的患者可以接受治疗。然而，手术切除的选择标准是可变的，并且常常因手术切除结果和其他新兴治疗方法的快速发展数据而有所不同。最近，两个主要的国际 HCC 管理实践指南几乎同时发布，即美国肝病研究协会 (AASLD) 和亚太肝病研究协会 (APASL) 的指南。这两个实践指南在手术切除方面的理念和实践有很大的不同。事实上，它们反映了现有共识意见的两个极端。AASLD 指南是从巴塞罗那肝癌临床 (BCLC) 指南发展而来的，与 APASL 指南相比，在手术切除方面更为保守。本文回顾了 HCC 手术切除标准中这些主要差异的科学依据，特别是在 HCC 特别常见的亚太地区的情况。
