1st Division of Gastroenterology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Eur J Gastroenterol Hepatol. 2013 Jun;25(6):639-51. doi: 10.1097/MEG.0b013e32835e33bb.
Hepatocellular carcinoma (HCC) is a complex disease with a poor prognosis. Incidence and mortality rates are increasing in many geographical regions, indicating a need for better management strategies. Among several risk factors for HCC, the most common are cirrhosis because of chronic hepatitis B virus or hepatitis C virus infection and alcohol consumption, obesity, and diabetes. In some patients, combined risk factors present additional challenges to the prevention and treatment of HCC. Screening and surveillance of high-risk populations varies widely by geographic regions, and access to optimal surveillance is critical for early diagnosis. The treatment choice for HCC depends on the cancer stage, patient performance status, and liver function and requires a multidisciplinary approach and close cooperation among specialists for the best patient outcomes. Despite advances in surgical treatments and locoregional therapies, recurrence and liver failure remain significant challenges. The pathogenesis of HCC is a multistep and complex process, wherein angiogenesis plays an important role. The multikinase inhibitor sorafenib is the only approved targeted agent for advanced HCC, although promising results have been obtained with other targeted agents and combinations, and the results of ongoing trials are eagerly awaited. Clinical trials with rigorous study designs, including molecular classification and validation of new molecular biomarkers, are required to improve the personalized treatment of HCC. This article provides an overview of HCC and was developed through a review of relevant literature, clinical trial data, and updated clinical guidelines.
肝细胞癌 (HCC) 是一种复杂的疾病,预后较差。在许多地理区域,发病率和死亡率都在上升,这表明需要更好的管理策略。在 HCC 的几个风险因素中,最常见的是由于慢性乙型肝炎病毒或丙型肝炎病毒感染和饮酒、肥胖和糖尿病引起的肝硬化。在一些患者中,联合风险因素给 HCC 的预防和治疗带来了额外的挑战。高风险人群的筛查和监测在地理区域上差异很大,获得最佳监测对于早期诊断至关重要。HCC 的治疗选择取决于癌症分期、患者的身体状况和肝功能,需要多学科方法和专家之间的密切合作,以获得最佳的患者结局。尽管手术治疗和局部区域治疗取得了进展,但复发和肝功能衰竭仍然是重大挑战。HCC 的发病机制是一个多步骤和复杂的过程,其中血管生成起着重要作用。多激酶抑制剂索拉非尼是唯一批准用于晚期 HCC 的靶向药物,尽管其他靶向药物和联合治疗取得了有希望的结果,并且正在等待正在进行的试验的结果。需要进行严格的研究设计的临床试验,包括分子分类和新分子生物标志物的验证,以改善 HCC 的个性化治疗。本文通过对相关文献、临床试验数据和最新临床指南的回顾,提供了 HCC 的概述。