Vogel Arndt, Meyer Tim, Sapisochin Gonzalo, Salem Riad, Saborowski Anna
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Research Department of Oncology, UCL Cancer Institute, University College London, Royal Free Hospital, London, UK.
Lancet. 2022 Oct 15;400(10360):1345-1362. doi: 10.1016/S0140-6736(22)01200-4. Epub 2022 Sep 6.
Hepatocellular carcinoma is one of the most common cancers worldwide and represents a major global health-care challenge. Although viral hepatitis and alcohol remain important risk factors, non-alcoholic fatty liver disease is rapidly becoming a dominant cause of hepatocellular carcinoma. A broad range of treatment options are available for patients with hepatocellular carcinoma, including liver transplantation, surgical resection, percutaneous ablation, and radiation, as well as transarterial and systemic therapies. As such, clinical decision making requires a multidisciplinary team that longitudinally adapts the individual treatment strategy according to the patient's tumour stage, liver function, and performance status. With the approval of new first-line agents and second-line agents, as well as the establishment of immune checkpoint inhibitor-based therapies as standard of care, the treatment landscape of advanced hepatocellular carcinoma is more diversified than ever. Consequently, the outlook for patients with hepatocellular carcinoma has improved. However, the optimal sequencing of drugs remains to be defined, and predictive biomarkers are urgently needed to inform treatment selection. In this Seminar, we present an update on the causes, diagnosis, molecular classification, and treatment of hepatocellular carcinoma.
肝细胞癌是全球最常见的癌症之一，也是全球主要的医疗保健挑战。虽然病毒性肝炎和酒精仍然是重要的危险因素，但非酒精性脂肪性肝病正迅速成为肝细胞癌的主要病因。肝细胞癌患者有多种治疗选择，包括肝移植、手术切除、经皮消融、放疗以及经动脉和全身治疗。因此，临床决策需要一个多学科团队，根据患者的肿瘤分期、肝功能和体能状态纵向调整个体化治疗策略。随着新的一线药物和二线药物的获批，以及基于免疫检查点抑制剂的疗法成为标准治疗方案，晚期肝细胞癌的治疗格局比以往任何时候都更加多样化。因此，肝细胞癌患者的前景有所改善。然而，药物的最佳排序仍有待确定，迫切需要预测性生物标志物来指导治疗选择。在本次研讨会上，我们介绍了肝细胞癌的病因、诊断、分子分类和治疗的最新情况。
