Fong Zhi Ven, Tanabe Kenneth K
Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Cancer. 2014 Sep 15;120(18):2824-38. doi: 10.1002/cncr.28730. Epub 2014 Jun 4.
Hepatocellular carcinoma (HCC), the most common primary malignancy of the liver, represents 1 of the leading causes of cancer deaths in the world with an estimated 21,670 deaths in the United States in 2013. In contrast to other malignancies, there is an array of treatment options for HCC involving several specialties in the multidisciplinary care of the patient. Consequently, vast heterogeneity in management tendencies has been observed. The objective of this report was to review and compare guidelines on the management of HCC from the United States (National Comprehensive Cancer Network), Europe (European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer), and Asia (consensus statement from the 2009 Asian Oncology Summit). By and large, all 3 guidelines are similar, with some variance in surveillance and treatment allocation recommendations because of regional differences in disease and other variables (diagnosis, staging systems) secondary to the lack of a concrete, high level of evidence. In contrast to other cancers, the geographic differences in tumor biology and resources make it impractical to have a globally universal guideline for all patients with HCC. Recommendations from the 3 groups are influenced by geographic differences in the prevalence and biology of the disease (ie, areas of increased hepatitis B prevalence) and available resources (organ availability for transplantation, finances, and accessibility to treatment). It is important for both physicians and policy makers to include these considerations when treating patients with HCC as well when structuring policies and guidelines.
肝细胞癌（HCC）是最常见的原发性肝癌，是全球癌症死亡的主要原因之一，2013年美国估计有21,670人死亡。与其他恶性肿瘤不同，HCC有一系列治疗选择，涉及患者多学科护理中的多个专业。因此，观察到管理倾向存在巨大异质性。本报告的目的是回顾和比较来自美国（国家综合癌症网络）、欧洲（欧洲肝脏研究协会 - 欧洲癌症研究与治疗组织）和亚洲（2009年亚洲肿瘤学峰会的共识声明）的HCC管理指南。总体而言，所有这3项指南都相似，由于疾病的区域差异以及缺乏具体、高水平证据导致的其他变量（诊断、分期系统），在监测和治疗分配建议方面存在一些差异。与其他癌症不同，肿瘤生物学和资源的地理差异使得为所有HCC患者制定全球通用指南不切实际。这3组的建议受到疾病患病率和生物学的地理差异（即乙肝患病率增加的地区）以及可用资源（移植器官的可用性、资金和治疗可及性）的影响。对于医生和政策制定者来说，在治疗HCC患者以及制定政策和指南时纳入这些考虑因素非常重要。
