Department of Radiology, Medstar Georgetown University Hospital, Georgetown University, 3800 Reservoir Rd, NW, Suite CG201, Washington DC, 20007, USA.
Medstar Georgetown Transplant Institute, Georgetown University, Washington DC, USA.
Abdom Radiol (NY). 2021 Aug;46(8):3528-3539. doi: 10.1007/s00261-021-03069-w. Epub 2021 Apr 9.
Hepatocellular carcinoma (HCC) offers unique management challenges as it commonly occurs in the setting of underlying chronic liver disease. The management of HCC is directed primarily by the clinical stage. The most commonly used staging system is the Barcelona-Clinic Liver Cancer system, which considers tumor burden based on imaging, liver function and the patient's performance status. Early-stage HCC can be managed with therapies of curative intent including surgical resection, liver transplantation, and ablative therapies. This manuscript reviews the various treatment options for HCC with a curative intent, such as locablative therapy types, surgical resection, and transplant. Indications, contraindications and outcomes of the various treatment options are reviewed. Multiple concepts relating to liver transplant are discussed including Milan criteria, OPTN policy, MELD exception points, downstaging to transplant and bridging to transplant.
肝细胞癌 (HCC) 因其常发生于潜在的慢性肝病背景下而具有独特的管理挑战。HCC 的管理主要取决于临床分期。最常用的分期系统是巴塞罗那临床肝癌系统，该系统根据影像学、肝功能和患者的体能状态来考虑肿瘤负荷。早期 HCC 可以通过具有治愈意图的治疗方法进行管理，包括手术切除、肝移植和消融治疗。本文综述了具有治愈意图的 HCC 的各种治疗选择，如局部消融治疗类型、手术切除和移植。本文回顾了各种治疗选择的适应证、禁忌证和结果。讨论了与肝移植相关的多个概念，包括米兰标准、OPTN 政策、MELD 例外积分、降期移植和桥接治疗。
