D'Avola Delia, Granito Alessandro, Torre-Aláez Manuel de la, Piscaglia Fabio
Liver Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona and Madrid, Spain; Centro de Investigación Bio Medica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Pamplona, Spain.
Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy.
J Hepatol. 2022 May;76(5):1185-1198. doi: 10.1016/j.jhep.2021.11.013. Epub 2021 Nov 15.
The aim of any oncological treatment is not just to eliminate the tumour, but to maximise patient survival and quality of life. Since the liver has a vital function, any radical treatment that severely compromises liver function will result in a shortening of life expectancy, rather than a prolongation. Furthermore, even non-severe liver damage may prevent the delivery of further effective therapies. This is particularly important in the case of hepatocellular carcinoma (HCC), as it is associated with underlying cirrhosis in most patients - cirrhosis itself is not only a potentially lethal disease and independent prognostic factor in HCC, but it also makes liver function fragile. Accordingly, some information about liver dysfunction is included in most staging systems for HCC and can be used to guide the selection of treatments that the functional liver reserve can tolerate. Unfortunately, the prediction of functional damage to the liver in the case of antitumor treatments is very challenging and still suboptimal in any given patient. Moreover, while the assessment of functional reserve can now be used to avoid postoperative liver failure in the surgical setting, its use has been less well clarified for non-surgical therapies, which is of particular relevance today, as several lines of effective non-surgical treatments, including systemic therapies, have become available. The present article will a) critically review the implications of the assessment of liver functional reserve in patients with HCC, b) illustrate the available tools to assess liver functional reserve and c) discuss the role of functional assessment for each type of non-surgical therapy for HCC.
任何肿瘤治疗的目的不仅是消除肿瘤，还要使患者的生存期和生活质量最大化。由于肝脏具有重要功能，任何严重损害肝功能的根治性治疗都会导致预期寿命缩短，而非延长。此外，即使是非严重的肝损伤也可能会妨碍进一步有效治疗的实施。这在肝细胞癌（HCC）的情况下尤为重要，因为大多数患者都伴有潜在的肝硬化——肝硬化本身不仅是一种潜在的致命疾病，也是HCC的独立预后因素，而且还会使肝功能变得脆弱。因此，大多数HCC分期系统中都包含了一些关于肝功能障碍的信息，可用于指导选择功能性肝储备能够耐受的治疗方法。不幸的是，在抗肿瘤治疗中预测肝脏的功能性损害非常具有挑战性，在任何特定患者中仍不尽人意。此外，虽然现在可以利用功能储备评估来避免手术中的术后肝衰竭，但对于非手术治疗而言，其应用尚不太明确，而这在当今尤为重要，因为包括全身治疗在内的几种有效的非手术治疗方法已经出现。本文将：a）批判性地回顾HCC患者肝功能储备评估的意义；b）说明评估肝功能储备的可用工具；c）讨论功能性评估对HCC每种非手术治疗类型的作用。
