Department of Surgery, University of California, Davis, CA, USA.
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
HPB (Oxford). 2021 May;23(5):753-761. doi: 10.1016/j.hpb.2020.09.013. Epub 2020 Sep 30.
There are many potential treatment options for patients with early stage hepatocellular carcinoma (HCC) and practice patterns vary widely. This project aimed to use a Delphi conference to generate consensus regarding the management of small resectable HCC.
A base case was established with review by members of AHPBA Research Committee. The Delphi panel of experts reviewed the literature and scored clinical case statements to identify areas of agreement and disagreement. Following initial scoring, discussion was undertaken, questions were amended, and scoring was repeated. This cycle was repeated until no further likelihood of reaching consensus existed.
The panel achieved agreement or disagreement consensus regarding 27 statements. The overarching themes included that resection, ablation, transplantation, or any locoregional therapy as a bridge to transplant were all appropriate modalities for early or recurrent HCC. For larger lesions, consensus was reached that radiofrequency ablation and microwave ablation were not appropriate treatments.
Using a validated system for identifying consensus, an expert panel agreed that multiple treatment modalities are appropriate for early stage HCC. These consensus guidelines are intended to help guide physicians through treatment modalities for early HCC; however, clinical decisions should continue to be made on a patient-specific basis.
对于早期肝细胞癌 (HCC) 患者，有许多潜在的治疗选择，且实践模式差异很大。本项目旨在通过德尔菲会议就小肝癌的治疗管理达成共识。
通过 AHPBA 研究委员会成员的审查，建立了一个基础病例。德尔菲专家组审查了文献并对临床病例陈述进行评分，以确定达成共识和存在分歧的领域。在初始评分后，进行了讨论、修改了问题并重复了评分。此循环重复进行，直到不再有可能达成共识为止。
专家组就 27 项声明达成了一致或不一致的共识。总体主题包括，切除、消融、移植或任何局部区域治疗作为移植的桥梁，对于早期或复发性 HCC 都是合适的治疗方式。对于更大的病变，专家组达成共识，认为射频消融和微波消融不是合适的治疗方法。
使用一种经过验证的识别共识的系统，专家组一致认为，多种治疗方式适用于早期 HCC。这些共识指南旨在帮助医生指导早期 HCC 的治疗方式；但是，临床决策应继续根据患者的具体情况做出。
