Arora Anil, Kumar Ashish
Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India.
J Clin Exp Hepatol. 2014 Aug;4(Suppl 3):S126-9. doi: 10.1016/j.jceh.2014.05.005. Epub 2014 Jun 24.
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. The management of HCC is evolving because of recently introduced novel therapeutic approaches. Optimal outcome requires an early and accurate assessment of tumor response to therapy. Current imaging modalities, such as computed tomography (CT) and magnetic resonance (MR) imaging; provide reliable and reproducible anatomical data in order to demonstrate tumor burden changes. However, in the setting of novel targeted therapies and liver directed treatments, simple tumor anatomical changes can be less informative and usually appear later than biological changes. There has been a growing interest to monitor the therapeutic response, at an early phase of treatment, by measuring tumor viability and/or perfusion. Therefore the importance of tumor viability assessment is increasingly being recognized. The tumor viability measurement guidelines have recently been amended to include the measurement of only the longest diameter of the enhancing tumors to formally amend RECIST to modified RECIST (mRECIST). Viable tumor should be defined as uptake of contrast agent in the arterial phase. In this review, we discuss criteria of response evaluation in HCC and further follow-up of patients receiving curative and palliative treatment.
肝细胞癌（HCC）是慢性肝病患者发病、死亡及医疗费用支出的主要原因之一。由于最近引入了新的治疗方法，HCC的管理正在不断发展。最佳治疗效果需要对肿瘤对治疗的反应进行早期准确评估。目前的成像方式，如计算机断层扫描（CT）和磁共振（MR）成像，可提供可靠且可重复的解剖学数据，以显示肿瘤负荷的变化。然而，在新型靶向治疗和肝脏定向治疗的背景下，单纯的肿瘤解剖学变化可能提供的信息较少，且通常比生物学变化出现得晚。通过测量肿瘤活性和/或灌注来在治疗早期监测治疗反应的兴趣日益浓厚。因此，肿瘤活性评估的重要性越来越受到认可。肿瘤活性测量指南最近已修订，仅测量强化肿瘤的最长径，以将实体瘤疗效评价标准（RECIST）正式修订为改良RECIST（mRECIST）。存活肿瘤应定义为动脉期有造影剂摄取。在本综述中，我们讨论了HCC反应评估的标准以及接受根治性和姑息性治疗患者的进一步随访。
