全球肝细胞癌的临床管理:2001 年至 2017 年现行指南的简明回顾与比较。
The clinical management of hepatocellular carcinoma worldwide: A concise review and comparison of current guidelines from 2001 to 2017.
机构信息
Graduate School of Frontier Sciences, The University of Tokyo.
Department of Bile Duct Surgery, West China Hospital, Sichuan University.
出版信息
Biosci Trends. 2017;11(4):389-398. doi: 10.5582/bst.2017.01202.
Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the second leading cause of cancer-related mortality worldwide. In this review, we made a review on current guidelines published from January 2001 to June 2017 worldwide with a focus on the clinical management of HCC. The electronic databases MEDLINE, the Chinese SinoMed, and the Japanese CiNii were systematically searched. A total of 18 characteristic guidelines for HCC management were finally included, including 8 guidelines from Asia, 5 from Europe, and 5 from the United States of America (USA). If guidelines were published in multiple versions, the most recent update was included, and surveillance, diagnosis, and treatment were compared. The composition of and recommendations in current guidelines on HCC varied, so these guidelines were regrouped and diagnostic and treatment algorithms were summarized graphically to provide the latest information to clinicians. The diagnostic criteria were grouped into 2 categories of a "Size-based pathway" and a "Non-size-based pathway." The treatment criteria were divided into 4 categories: i) Criteria based on the Barcelona Clinic Liver Cancer staging system; ii) Criteria based on the modified Union of International Cancer Control staging system; iii) Criteria based on the Child-Pugh class of liver function; and iv) Criteria based on tumor resectability. Findings from comparison of current guidelines might help target and concentrate efforts to improve the clinical management of HCC. However, further studies are needed to improve the management and outcomes of HCC. More straightforward or refined guidelines would help guide doctors to make better decisions in the treatment of HCC in the future.
肝细胞癌(HCC)是全球第五大常见恶性肿瘤,也是癌症相关死亡的第二大主要原因。在本综述中,我们对 2001 年 1 月至 2017 年 6 月期间全球发表的现行指南进行了回顾,重点关注 HCC 的临床管理。系统地检索了 MEDLINE、中国生物医学文献数据库(SinoMed)和日本 Cinii 电子数据库。最终共纳入 18 项 HCC 管理特征性指南,其中包括 8 项来自亚洲、5 项来自欧洲和 5 项来自美国。如果指南有多个版本,则纳入最新更新版本,并对监测、诊断和治疗进行比较。当前 HCC 指南的组成和建议存在差异,因此对这些指南进行了重新分组,并以图形方式总结了诊断和治疗算法,为临床医生提供最新信息。诊断标准分为“基于大小的途径”和“非基于大小的途径”两类。治疗标准分为四类:i)巴塞罗那临床肝癌分期系统标准;ii)改良国际抗癌联盟分期系统标准;iii)肝功能 Child-Pugh 分级标准;和 iv)肿瘤可切除性标准。对现行指南的比较结果可能有助于有针对性地集中精力改善 HCC 的临床管理。然而,需要进一步的研究来改善 HCC 的管理和预后。更直接或更精细的指南将有助于指导医生在未来治疗 HCC 时做出更好的决策。