Brown Zachary J, Tsilimigras Diamantis I, Ruff Samantha M, Mohseni Alireza, Kamel Ihab R, Cloyd Jordan M, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus.
Department of Radiology, John Hopkins University, Baltimore, Maryland.
JAMA Surg. 2023 Apr 1;158(4):410-420. doi: 10.1001/jamasurg.2022.7989.
Hepatocellular carcinoma (HCC) is the sixth most common malignancy and fourth leading cause of cancer-related death worldwide. Recent advances in systemic and locoregional therapies have led to changes in many guidelines regarding systemic therapy, as well as the possibility to downstage patients to undergo resection. This review examines the advances in surgical and medical therapies relative to multidisciplinary treatment strategies for HCC.
HCC is a major health problem worldwide. The obesity epidemic has made nonalcoholic fatty liver disease a major risk factor for the development of HCC. Multiple societies, such as the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, the Asian Pacific Association for the Study of the Liver, and the National Comprehensive Cancer Network, provide guidelines for screening at-risk patients, as well as define staging systems to guide optimal treatment strategies. The Barcelona Clinic Liver Cancer staging system is widely accepted and has recently undergone updates with the introduction of new systemic therapies and stage migration.
The treatment of patients with HCC should involve a multidisciplinary approach with collaboration among surgeons, medical oncologists, radiation oncologists, and interventional radiologists to provide optimal care. Treatment paradigms must consider both tumor and patient-related factors such as extent of liver disease, which is a main driver of morbidity and mortality. The advent of more effective systemic and locoregional therapies has prolonged survival among patients with advanced disease and allowed some patients to undergo surgical intervention who would otherwise have disease considered unresectable.
肝细胞癌（HCC）是全球第六大常见恶性肿瘤，也是癌症相关死亡的第四大主要原因。全身和局部区域治疗的最新进展导致许多关于全身治疗的指南发生了变化，同时也使患者有可能降期接受手术切除。本综述探讨了相对于HCC多学科治疗策略的手术和药物治疗进展。
HCC是全球主要的健康问题。肥胖流行使非酒精性脂肪性肝病成为HCC发生的主要危险因素。多个学会，如美国肝病研究协会、欧洲肝病研究协会、亚太肝病研究协会和美国国立综合癌症网络，为筛查高危患者提供指南，并定义分期系统以指导最佳治疗策略。巴塞罗那临床肝癌分期系统被广泛接受，并且随着新的全身治疗方法的引入和分期迁移，最近进行了更新。
HCC患者的治疗应采用多学科方法，外科医生、医学肿瘤学家、放射肿瘤学家和介入放射学家之间进行协作，以提供最佳治疗。治疗模式必须考虑肿瘤和患者相关因素，如肝脏疾病的程度，这是发病率和死亡率的主要驱动因素。更有效的全身和局部区域治疗方法的出现延长了晚期疾病患者的生存期，并使一些原本被认为无法切除的患者能够接受手术干预。
