Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States.
Br J Radiol. 2022 Sep 1;95(1138):20220379. doi: 10.1259/bjr.20220379. Epub 2022 Aug 4.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. Liver transplant remains the goal of curative treatment, but limited supply of organs decreases accessibility and prolongs waiting time to transplantation. Therefore, interventional oncology therapies have been used to treat the majority of HCC patients, including those awaiting transplant. The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system in management of HCC that helps allocate treatments. Since its inception in 1999, it was updated for the fifth time in November 2021 and for the first time shaped by expert opinions outside the core BCLC group. The most recent version includes additional options for early-stage disease, substratifies intermediate disease into three groups, and lists alternates to Sorafenib that can double the expected survival of advanced-stage disease. The group also proposed a new BCLC staging schema for disease progression, and endorsed treatment stage migration (TSM) directly into the main staging and treatment algorithm. This article reviews the recent developments underlying the current BCLC guidelines and highlights ongoing research, particularly involving radioembolization, that will shape future best practice.
肝细胞癌（HCC）是全球癌症相关死亡的主要原因。肝移植仍然是治愈治疗的目标，但器官供应有限，降低了可及性并延长了移植等待时间。因此，介入肿瘤学治疗已被用于治疗大多数 HCC 患者，包括那些等待移植的患者。巴塞罗那临床肝癌（BCLC）分期是最广泛用于 HCC 管理的分期系统，有助于分配治疗方法。自 1999 年成立以来，它于 2021 年 11 月进行了第五次更新，并且首次由 BCLC 核心小组以外的专家意见塑造。最新版本为早期疾病增加了其他选择，将中期疾病分为三组，并列出了可以将晚期疾病的预期生存时间延长一倍的索拉非尼替代品。该小组还为疾病进展提出了新的 BCLC 分期方案，并支持治疗阶段迁移（TSM）直接进入主要分期和治疗算法。本文回顾了当前 BCLC 指南背后的最新发展，并强调了正在进行的研究，特别是涉及放射栓塞的研究，这些研究将塑造未来的最佳实践。
