Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Department of Internal Medicine III, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Int J Mol Sci. 2019 Mar 22;20(6):1465. doi: 10.3390/ijms20061465.
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and its mortality is third among all solid tumors, behind carcinomas of the lung and the colon. Despite continuous advancements in the management of this disease, the prognosis for HCC remains inferior compared to other tumor entities. While orthotopic liver transplantation (OLT) and surgical resection are the only two curative treatment options, OLT remains the best treatment strategy as it not only removes the tumor but cures the underlying liver disease. As the applicability of OLT is nowadays limited by organ shortage, major liver resections ⁻ even in patients with underlying chronic liver disease ⁻ are adopted increasingly into clinical practice. Against the background of the oftentimes present chronical liver disease, locoregional therapies have also gained increasing significance. These strategies range from radiofrequency ablation and trans-arterial chemoembolization to selective internal radiation therapy and are employed in both curative and palliative intent, individually, as a bridging to transplant or in combination with liver resection. The choice of the appropriate treatment, or combination of treatments, should consider the tumor stage, the function of the remaining liver parenchyma, the future liver remnant volume and the patient's general condition. This review aims to address the topic of multimodal treatment strategies in HCC, highlighting a multidisciplinary treatment approach to further improve outcome in these patients.
肝细胞癌 (HCC) 是肝脏最常见的原发性肿瘤，其死亡率在所有实体肿瘤中排名第三，仅次于肺癌和结肠癌。尽管在这种疾病的治疗方面不断取得进展，但 HCC 的预后仍不如其他肿瘤实体。虽然原位肝移植 (OLT) 和手术切除是仅有的两种治愈性治疗选择，但 OLT 仍然是最佳的治疗策略，因为它不仅可以去除肿瘤，还可以治愈潜在的肝脏疾病。由于 OLT 的适用性目前受到器官短缺的限制，越来越多的主要肝切除术 ⁇ 即使在患有潜在慢性肝病的患者中 ⁇ 也被越来越多地应用于临床实践。在经常存在的慢性肝病的背景下，局部区域治疗也具有越来越重要的意义。这些策略包括射频消融和经动脉化疗栓塞到选择性内放射治疗，这些策略可单独用于治愈或姑息治疗，作为移植的桥接手段，或与肝切除术联合使用。选择适当的治疗方法或联合治疗方法时，应考虑肿瘤分期、剩余肝实质的功能、剩余肝体积和患者的一般状况。这篇综述旨在探讨 HCC 的多模式治疗策略，强调多学科治疗方法以进一步改善这些患者的预后。
