Mokdad Ali A, Hester Caitlin A, Singal Amit G, Yopp Adam C
Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA.
Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA.
Chin Clin Oncol. 2017 Apr;6(2):21. doi: 10.21037/cco.2017.04.04.
Hepatocellular carcinoma (HCC) is a major cause of cancer burden globally. In the United States, the incidence of HCC is forecast to continue to rise for the next 15 years. Patients with HCC vary markedly owing to heterogeneous tumor characteristics and concomitant liver dysfunction. In the United States and Europe, HCC is staged and managed according to the Barcelona Clinic Liver Cancer (BCLC) system. For very early and early stage HCC, or BCLC 0/A, liver transplant is the optimal treatment option. Liver resection and radiofrequency or microwave ablation are alternative treatment options. For intermediate stage HCC, or BCLC B, transarterial chemoembolization (TACE) is the standard of care. An alternative locoregional therapy, transarterial radioembolization using yttrium-90, has shown comparable outcomes with TACE and may be used in patients for whom TACE is contraindicated. For advanced stage HCC, or BCLC C, systemic chemotherapy with sorafenib, a multikinase inhibitor, is the only evidence-based treatment option available. Another multikinase inhibitor, regorafenib, was recently approved as a second-line therapy for this patient group. Randomized clinical trials investigating other agents in enriched patient groups and novel therapeutics including checkpoint inhibitors are underway. Patient with prohibitive performance status and/or end stage liver dysfunction are classified terminal stage HCC, or BCLC D, and are managed with best supportive care. The future direction for the management of HCC will rely on continuing efforts to uncover molecular pathways and actionable genetic aberrations in HCC.
肝细胞癌（HCC）是全球癌症负担的主要原因。在美国，预计未来15年HCC的发病率将持续上升。由于肿瘤特征异质性和伴随的肝功能障碍，HCC患者差异显著。在美国和欧洲，HCC根据巴塞罗那临床肝癌（BCLC）系统进行分期和管理。对于极早期和早期HCC，即BCLC 0/A期，肝移植是最佳治疗选择。肝切除和射频或微波消融是替代治疗选择。对于中期HCC，即BCLC B期，经动脉化疗栓塞（TACE）是标准治疗方法。一种替代的局部区域治疗方法，即使用钇-90的经动脉放射性栓塞，已显示出与TACE相当的疗效，可用于TACE禁忌的患者。对于晚期HCC，即BCLC C期，使用多激酶抑制剂索拉非尼进行全身化疗是唯一可用的循证治疗选择。另一种多激酶抑制剂瑞戈非尼最近被批准作为该患者群体的二线治疗药物。正在开展针对特定患者群体中其他药物以及包括检查点抑制剂在内的新型疗法的随机临床试验。具有严重身体状况和/或终末期肝功能障碍的患者被归类为终末期HCC，即BCLC D期，并采用最佳支持治疗。HCC管理的未来方向将依赖于持续努力揭示HCC中的分子途径和可操作的基因异常。
