Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, , Barcelona, Spain.
Gut. 2014 May;63(5):844-55. doi: 10.1136/gutjnl-2013-306627. Epub 2014 Feb 14.
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death and is currently the main event leading to death in patients with cirrhosis. Evolving information suggests that the metabolic syndrome with non-alcoholic liver disease may be an important cause of HCC in addition to viral hepatitis and alcohol-induced liver disease. The molecular pathogenesis is extremely complex and heterogeneous. To date the molecular information has not impacted on treatment decisions. Periodic surveillance imaging of patients with cirrhosis is widely practiced, especially because diagnostic, radiographic criteria for early-stage HCC have been defined (including nodules between 1 and 2 cm) and effective treatment is available for tumours detected at an early stage. Worldwide the approach to resection versus transplantation varies depending upon local resources, expertise and donor availability. The criteria for transplantation are discussed, and the controversial areas highlighted with evidence-based recommendations provided. Several approaches are available for intermediate stage disease, including radiofrequency ablation, transarterial chemoembolisation and radioembolisation; the rationale for these therapies is buttressed by appropriate outcome-based studies. For advanced disease, systemic therapy with sorafenib remains the option best supported by current data. Thus, while several trials have failed to improve the benefits of established therapies, studies assessing the sequential or combined application of those already known to be beneficial are needed. Also, new concepts are provided in regards to selecting and stratifying patients for second-line studies, which may help explain the failure of prior studies.
肝细胞癌（HCC）是癌症相关死亡的主要原因之一，也是目前导致肝硬化患者死亡的主要原因。不断发展的信息表明，除了病毒性肝炎和酒精性肝病之外，非酒精性肝病的代谢综合征可能是 HCC 的一个重要原因。分子发病机制极其复杂和异质。迄今为止，分子信息并未对治疗决策产生影响。定期对肝硬化患者进行影像学监测已广泛开展，这主要是因为已经定义了早期 HCC 的诊断、影像学标准（包括 1 至 2 厘米之间的结节），并且可以对早期发现的肿瘤进行有效治疗。在全球范围内，切除与移植的方法因当地资源、专业知识和供体可用性而异。本文讨论了移植的标准，并提供了基于证据的建议来突出有争议的领域。对于中期疾病，有几种方法可供选择，包括射频消融、经动脉化疗栓塞和放射性栓塞；这些治疗方法的合理性得到了适当的基于结果的研究的支持。对于晚期疾病，索拉非尼的系统治疗仍然是目前数据支持的最佳选择。因此，虽然几项试验未能提高既定治疗方法的益处，但需要评估那些已知有益的治疗方法的序贯或联合应用的研究。此外，还提供了有关选择和分层二线研究患者的新概念，这可能有助于解释先前研究的失败。
