Saraswat Vivek A, Pandey Gaurav, Shetty Sachin
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Clin Exp Hepatol. 2014 Aug;4(Suppl 3):S80-9. doi: 10.1016/j.jceh.2014.05.004. Epub 2014 Jun 6.
Early diagnosis and aggressive therapy improves outcome in hepatocellular carcinoma (HCC). Several potentially curative as well as palliative treatment options are available for patients. The choice of therapy is influenced by factors such as extent of tumor and severity of underlying liver dysfunction as well as availability of resources and of expertise. A systematic, algorithmic approach would ensure optimal therapy for each patient and is likely to improve outcomes. Even after receiving therapy for HCC, patients remain at risk for recurrent HCC as well as progression of underlying cirrhosis. Proper assessment and monitoring is needed for the underlying liver disease, which may progress to liver failure and have a major impact on long-term survival. Comprehensive care for patients with cirrhosis includes interventions such as antiviral therapy for HBV and HCV, abstention from alcohol, management of fatty liver disease, endoscopic surveillance and treatment for complications of portal hypertension and, if indicated, immunization against HAV and HBV. An algorithmic approach is useful for choosing the most appropriate treatment option for the individual patient from among the various options that are available. The general consensus is that the BCLC system should be preferred for staging HCC as it is useful in predicting outcomes and planning treatment. The BCLC system classifies patients with HCC into five categories: very early, early, intermediate, advanced, and terminal. It incorporates data on tumor status (number and size of nodules, vascular invasion, extra-hepatic spread), liver function (CTP status, presence of portal hypertension) and overall health status (constitutional symptoms, cancer symptoms, performance status). Treatment allocation according to sub-class of patients is a merit of the BCLC system; a few limitations have been noted, particularly with respect to patients with BCLC stage B and C disease. The treatment algorithm as per BCLC system is summarized in this review.
早期诊断和积极治疗可改善肝细胞癌（HCC）的预后。对于患者有几种潜在的治愈性以及姑息性治疗选择。治疗方案的选择受肿瘤范围、潜在肝功能障碍的严重程度以及资源和专业知识的可用性等因素影响。一种系统的、循算法的方法将确保为每位患者提供最佳治疗，并可能改善预后。即使接受了HCC治疗，患者仍有复发性HCC以及潜在肝硬化进展的风险。需要对潜在的肝脏疾病进行适当评估和监测，其可能进展为肝衰竭并对长期生存产生重大影响。对肝硬化患者的综合护理包括抗病毒治疗（针对HBV和HCV）、戒酒、脂肪肝疾病管理、内镜监测以及门静脉高压并发症的治疗，如有指征，还包括甲型肝炎和乙型肝炎免疫接种。循算法的方法有助于从各种可用选项中为个体患者选择最合适的治疗方案。普遍的共识是，BCLC系统应优先用于HCC分期，因为它有助于预测预后和规划治疗。BCLC系统将HCC患者分为五类：极早期、早期、中期、晚期和终末期。它纳入了肿瘤状态（结节数量和大小、血管侵犯、肝外转移）、肝功能（CTP状态、门静脉高压的存在）和总体健康状况（全身症状、癌症症状、体能状态）的数据。根据患者亚类进行治疗分配是BCLC系统的一个优点；也注意到了一些局限性，特别是对于BCLC B期和C期疾病的患者。本综述总结了根据BCLC系统的治疗算法。
