Forner Alejandro, Díaz-González Alvaro, Liccioni Alexandre, Vilana Ramón
Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain.
Best Pract Res Clin Gastroenterol. 2014 Oct;28(5):855-65. doi: 10.1016/j.bpg.2014.08.002. Epub 2014 Aug 23.
Staging and prognosis assessment are critical steps in the management of patients with hepatocellular carcinoma. This cancer is a complex disease usually associated with chronic liver disease, and any attempt to assess the prognosis should consider tumour burden, degree of liver function impairment and evaluation of cancer-related symptoms. In addition, for any staging system to be meaningful it has to link staging with treatment indication and this should be based on robust scientific data. Currently, the only proposal that serves both aims is the Barcelona Clinic Liver Cancer (BCLC) staging system. It divides patients into very early/early, intermediate, advanced and end-stage. Very early/early stage HCC patients should be considered for potentially curative options such as resection, transplantation and ablation. Patients at intermediate stage benefit from chemoembolization, while patients at an advanced stage or who cannot benefit of options of higher priority have sorafenib as standard of care. Finally, patients at end-stage should receive best supportive care.
分期和预后评估是肝细胞癌患者管理中的关键步骤。这种癌症是一种通常与慢性肝病相关的复杂疾病，任何评估预后的尝试都应考虑肿瘤负荷、肝功能损害程度以及癌症相关症状的评估。此外，任何分期系统要具有意义，就必须将分期与治疗指征联系起来，而这应该基于可靠的科学数据。目前，唯一能同时满足这两个目标的提议是巴塞罗那临床肝癌（BCLC）分期系统。它将患者分为极早期/早期、中期、晚期和终末期。极早期/早期肝癌患者应考虑潜在的治愈性选择，如切除、移植和消融。中期患者从化疗栓塞中获益，而晚期患者或无法从更高优先级选择中获益的患者则以索拉非尼作为标准治疗。最后，终末期患者应接受最佳支持治疗。
