Karagiannakis Dimitrios S
Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 12462 Athens, Greece.
Cancers (Basel). 2023 Dec 21;16(1):51. doi: 10.3390/cancers16010051.
Hepatocellular carcinoma (HCC) represents an entity of poor prognosis, especially in cases of delayed diagnosis. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, patients in BCLC-A are the most suitable for potentially curative treatments (surgery or radiofrequency ablation), whereas those in BCLC-C should be treated only with systemic treatment, as locoregional interventions are ineffective due to the tumor's extensiveness. For patients in the BCLC-B stage, trans-arterial chemoembolization (TACE) is the reference treatment, but the role of systemic treatment has been constantly increasing. As this group of patients is extremely heterogeneous, a case-by-case therapeutic strategy instead of a one-fits-all treatment is certainly required to achieve adequate results against HCC. The decision of selecting among immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), TACE, or a combination of them depends on the patient's tumor load, the severity of liver dysfunction, the general performance status, and the presence of concomitant extrahepatic diseases. The objective of this review is to critically appraise the recent data regarding the systemic treatment of BCLC-B HCCs, aiming to emphasize its potential role in the management of these difficult-to-treat patients.
肝细胞癌（HCC）预后较差，尤其是诊断延迟的病例。根据巴塞罗那临床肝癌（BCLC）分期系统，BCLC - A期患者最适合接受潜在的根治性治疗（手术或射频消融），而BCLC - C期患者应仅接受全身治疗，因为由于肿瘤范围广泛，局部区域干预无效。对于BCLC - B期患者，经动脉化疗栓塞术（TACE）是标准治疗方法，但全身治疗的作用一直在不断增加。由于这组患者极其异质性，肯定需要针对具体病例制定治疗策略而非一刀切的治疗方法，才能取得对抗HCC的充分疗效。在免疫检查点抑制剂（ICI）、酪氨酸激酶抑制剂（TKI）、TACE或它们的组合之间进行选择，取决于患者的肿瘤负荷、肝功能障碍的严重程度、总体体能状态以及是否存在合并的肝外疾病。本综述的目的是批判性地评估关于BCLC - B期HCC全身治疗的最新数据，旨在强调其在管理这些难治性患者中的潜在作用。
