Division of Surgery and Cancer, Hammersmith Campus of Imperial College London, London, UK.
Centre for Population Health, MacFarlane-Burnet Institute, Melbourne, VIC, Australia.
Aliment Pharmacol Ther. 2017 Jun;45(12):1514-1523. doi: 10.1111/apt.14066. Epub 2017 Apr 25.
Intermediate-stage hepatocellular carcinoma (HCC), for which trans-arterial chemoembolization (TACE) constitutes the standard of care, is a patient subgroup with significant heterogeneity in clinical outcome. Sources of variation relate to differences in tumour burden, hepatic reserve, ethnicity and treatment modalities. Increasing research efforts have been dedicated to minimise the clinical diversity of this patient population and enhance optimal provision of treatment.
To comprehensively review the diverse prognostic models that have been proposed to refine the prognostic prediction of patients with HCC undergoing TACE.
A number of prognostic algorithms (HAP, ART, ABCR score and many others) have shown potential to address the clinical heterogeneity characterising patients with intermediate-stage HCC and facilitate early identification of patients with poor prognostic features in whom alternative treatments or best supportive care might be more appropriate than TACE.
While an improved characterisation of intermediate-stage HCC is a highly important clinical aim, current evidence suggests that novel prognostic algorithms in this patient population may offer potential benefits but non-negligible challenges in the provision of TACE. This review summarises the currently available evidence to facilitate the development of precision oncology in intermediate-stage HCC.
中期肝细胞癌（HCC）是经动脉化疗栓塞（TACE）治疗的标准适应证，但患者的临床结局存在显著异质性。导致这种差异的原因包括肿瘤负荷、肝脏储备、种族和治疗方式的不同。为了减少该患者人群的临床差异，并优化治疗方案，越来越多的研究致力于此。
全面回顾已提出的各种预后模型，以改善 TACE 治疗 HCC 患者的预后预测。
一些预后算法（HAP、ART、ABCR 评分等）已显示出有潜力解决中期 HCC 患者的临床异质性问题，并有助于早期识别预后不良的患者，对于这些患者，可能更适合采用替代治疗或最佳支持治疗，而不是 TACE。
尽管改善中期 HCC 的特征是一个非常重要的临床目标，但目前的证据表明，该患者人群中的新型预后算法可能具有潜在益处，但在 TACE 治疗中存在不可忽视的挑战。本综述总结了目前的可用证据，以促进中期 HCC 的精准肿瘤学发展。
