Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
AJR Am J Roentgenol. 2020 Jul;215(1):223-234. doi: 10.2214/AJR.19.22098. Epub 2020 Apr 7.
Treatment options for hepatocellular carcinoma (HCC) continue to expand. However, given the complexity of the patients including factors such as codominant cirrhosis or portal hypertension and transplant status, it can be difficult to know which treatment is most advantageous. The choice of HCC treatment is perhaps most complex in the setting of HCCs that are 3-5 cm. This article reviews the evidence for locoregional therapies in treating 3- to 5-cm HCCs. Combination therapy with transarterial chemoembolization (TACE) and ablation has the most robust and highest level of evidence to support its efficacy and therefore should be considered first-line therapy for nonresectable HCCs that measure 3-5 cm. The studies support that TACE followed by ablation is superior to either TACE alone or ablation alone. Data for transarterial radioembolization (TARE) to treat HCCs in this specific size range are very limited. Additional data are needed about the comparative effectiveness of TACE-ablation combination and TARE and how the TACE-ablation combination compares with surgical resection.
治疗肝细胞癌（HCC）的选择不断增多。然而，由于患者的复杂性，包括共显性肝硬化或门静脉高压和移植状态等因素，很难知道哪种治疗最有利。在 3-5cm HCC 中，HCC 的治疗选择可能最为复杂。本文综述了局部区域治疗治疗 3-5cm HCC 的证据。经动脉化疗栓塞（TACE）联合消融的联合治疗具有最有力和最高水平的证据支持其疗效，因此应被视为测量 3-5cm 的不可切除 HCC 的一线治疗方法。研究支持 TACE 后消融优于单独 TACE 或单独消融。关于经动脉放射性栓塞（TARE）治疗该特定大小范围 HCC 的数据非常有限。需要更多关于 TACE-消融联合治疗与 TARE 的比较效果的数据，以及 TACE-消融联合治疗与手术切除的比较。
