Molla N, AlMenieir N, Simoneau E, Aljiffry M, Valenti D, Metrakos P, Boucher L M, Hassanain M
Department of Radiology, King Saud University, Riyadh, Saudi Arabia. ; Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC.
Department of Radiology, King Saud University, Riyadh, Saudi Arabia.
Curr Oncol. 2014 Jun;21(3):e480-92. doi: 10.3747/co.21.1829.
Hepatocellular carcinoma (hcc) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced hcc or as a bridging therapy for patients with early and intermediate disease. This article reviews and evaluates the role of interventional radiology in the management of such cases by assessing various aspects of each method, such as effect on rates of survival, recurrence, tumour response, and complications.
A systemic search of PubMed, medline, Ovid Medline In-Process, and the Cochrane Database of Systematic Reviews retrieved all related scientific papers for review.
Needle core biopsy is a highly sensitive, specific, and accurate method for hcc grading. Portal-vein embolization provides adequate expansion of the future liver remnant, making more patients eligible for resection. In focal or multifocal unresectable early-stage disease, radiofrequency ablation tops all other thermoablative methods. However, microwave ablation is preferred in large tumours and in patients with Child-Pugh B disease. Cryoablation is preferred in recurrent disease and in patients who are poor candidates for anesthesia. Of the various transarterial modalities-transarterial chemoembolization (tace), drug-eluting beads, and transarterial radio-embolization (tare)-tace is the method of choice in Child-Pugh A disease, and tare is the method of choice in hcc cases with portal vein thrombosis.
The existing data support the importance of a multidisciplinary approach in hcc management. Large randomized controlled studies are needed to provide clear indication guidelines for each method.
肝细胞癌（HCC）是全球癌症相关死亡的最常见原因之一。总体而言，肝移植和肝切除术是仅有的有治愈潜力的治疗方法。各种局部区域治疗被广泛用于治疗晚期HCC患者或作为早期和中期疾病患者的桥接治疗。本文通过评估每种方法的各个方面，如对生存率、复发率、肿瘤反应和并发症的影响，来综述和评估介入放射学在此类病例管理中的作用。
对PubMed、Medline、Ovid Medline In-Process和Cochrane系统评价数据库进行系统检索，以获取所有相关科学论文进行综述。
针芯活检是一种用于HCC分级的高度敏感、特异且准确的方法。门静脉栓塞可使未来肝残余充分增大，使更多患者符合肝切除条件。在局限性或多灶性不可切除的早期疾病中，射频消融优于所有其他热消融方法。然而，微波消融在大肿瘤和Child-Pugh B级疾病患者中更受青睐。冷冻消融在复发性疾病和麻醉风险高的患者中更受青睐。在各种经动脉治疗方式——经动脉化疗栓塞（TACE）、载药微球和经动脉放射性栓塞（TARE）中，TACE是Child-Pugh A级疾病的首选方法，TARE是门静脉血栓形成的HCC病例的首选方法。
现有数据支持多学科方法在HCC管理中的重要性。需要开展大型随机对照研究，为每种方法提供明确的适应证指南。
