Barcelona Clinic Liver Cancer group, Liver Unit, Hospital Clínic Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
Lancet. 2012 Mar 31;379(9822):1245-55. doi: 10.1016/S0140-6736(11)61347-0. Epub 2012 Feb 20.
Hepatocellular carcinoma is the sixth most prevalent cancer and the third most frequent cause of cancer-related death. Patients with cirrhosis are at highest risk of developing this malignant disease, and ultrasonography every 6 months is recommended. Surveillance with ultrasonography allows diagnosis at early stages when the tumour might be curable by resection, liver transplantation, or ablation, and 5-year survival higher than 50% can be achieved. Patients with small solitary tumours and very well preserved liver function are the best candidates for surgical resection. Liver transplantation is most beneficial for individuals who are not good candidates for resection, especially those within Milano criteria (solitary tumour ≤5 cm and up to three nodules ≤3 cm). Donor shortage greatly limits its applicability. Percutaneous ablation is the most frequently used treatment but its effectiveness is limited by tumour size and localisation. In asymptomatic patients with multifocal disease without vascular invasion or extrahepatic spread not amenable to curative treatments, chemoembolisation can provide survival benefit. Findings of randomised trials of sorafenib have shown survival benefits for individuals with advanced hepatocellular carcinoma, suggesting that molecular-targeted therapies could be effective in this chemoresistant cancer. Research is active in the area of pathogenesis and treatment of hepatocellular carcinoma.
肝细胞癌是第六大常见癌症，也是癌症相关死亡的第三大主要原因。肝硬化患者患这种恶性疾病的风险最高，建议每 6 个月进行一次超声检查。超声检查监测可在肿瘤可通过切除、肝移植或消融治愈的早期阶段进行诊断，并且可以实现超过 50%的 5 年生存率。具有单个小肿瘤和肝功能良好的患者是手术切除的最佳候选者。肝移植最有益于不适合切除的患者，尤其是符合米兰标准的患者（单个肿瘤≤5cm 且最多三个结节≤3cm）。供体短缺极大地限制了其适用性。经皮消融是最常用的治疗方法，但由于肿瘤大小和位置的限制，其效果有限。对于无法进行根治性治疗的多灶性疾病、无血管侵犯或肝外扩散且无症状的患者，化疗栓塞可提供生存获益。索拉非尼的随机试验结果表明，晚期肝细胞癌患者的生存获益，这表明分子靶向治疗可能对这种化疗耐药的癌症有效。在肝细胞癌的发病机制和治疗领域的研究非常活跃。
