Yalcin Suayib, Lacin Sahin, Kaseb Ahmed Omar, Peynircioğlu Bora, Cantasdemir Murat, Çil Barbaros Erhan, Hurmuz Pervin, Doğrul Ahmet Bülent, Bozkurt Murat Fani, Abali Hüseyin, Akhan Okan, Şimşek Halis, Sahin Berksoy, Aykan Faruk N, Yücel İdris, Tellioğlu Gürkan, Selçukbiricik Fatih, Philip Philip A
Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Medical Oncology, Koç University Faculty of Medicine, İstanbul, Turkey.
J Hepatocell Carcinoma. 2024 May 29;11:953-974. doi: 10.2147/JHC.S449540. eCollection 2024.
Hepatocellular carcinoma (HCC), the most prevalent liver tumor, is usually linked with chronic liver diseases, particularly cirrhosis. As per the 2020 statistics, this cancer ranks 6th in the list of most common cancers worldwide and is the third primary source of cancer-related deaths. Asia holds the record for the highest occurrence of HCC. HCC is found three times more frequently in men than in women. The primary risk factors for HCC include chronic viral infections, excessive alcohol intake, steatotic liver disease conditions, as well as genetic and family predispositions. Roughly 40-50% of patients are identified in the late stages of the disease. Recently, there have been significant advancements in the treatment methods for advanced HCC. The selection of treatment for HCC hinges on the stage of the disease and the patient's medical status. Factors such as pre-existing liver conditions, etiology, portal hypertension, and portal vein thrombosis need critical evaluation, monitoring, and appropriate treatment. Depending on the patient and the characteristics of the disease, liver resection, ablation, or transplantation may be deemed potentially curative. For inoperable lesions, arterially directed therapy might be an option, or systemic treatment might be deemed more suitable. In specific cases, the recommendation might extend to external beam radiation therapy. For all individuals, a comprehensive, multidisciplinary approach should be adopted when considering HCC treatment options. The main treatment strategies for advanced HCC patients are typically combination treatments such as immunotherapy and anti-VEGFR inhibitor, or a combination of immunotherapy and immunotherapy where appropriate, as a first-line treatment. Furthermore, some TKIs and immune checkpoint inhibitors may be used as single agents in cases where patients are not fit for the combination therapies. As second-line treatments, some treatment agents have been reported and can be considered.
肝细胞癌(HCC)是最常见的肝脏肿瘤,通常与慢性肝病,尤其是肝硬化有关。根据2020年的统计数据,这种癌症在全球最常见癌症名单中排名第六,是癌症相关死亡的第三大主要原因。亚洲的HCC发病率最高。男性患HCC的频率是女性的三倍。HCC的主要危险因素包括慢性病毒感染、过量饮酒、脂肪性肝病状况以及遗传和家族易感性。大约40%-50%的患者在疾病晚期被确诊。最近,晚期HCC的治疗方法有了重大进展。HCC的治疗选择取决于疾病阶段和患者的医疗状况。诸如既往肝脏疾病、病因、门静脉高压和门静脉血栓形成等因素需要进行严格评估、监测和适当治疗。根据患者和疾病特征,肝切除、消融或移植可能被视为有潜在治愈可能。对于无法手术的病变,动脉导向治疗可能是一种选择,或者全身治疗可能被认为更合适。在特定情况下,建议可能会扩展到外照射放疗。对于所有患者,在考虑HCC治疗方案时应采用全面的多学科方法。晚期HCC患者的主要治疗策略通常是联合治疗,如免疫治疗和抗血管内皮生长因子受体(VEGFR)抑制剂,或在适当情况下免疫治疗与免疫治疗联合,作为一线治疗。此外,在患者不适合联合治疗的情况下,一些酪氨酸激酶抑制剂(TKIs)和免疫检查点抑制剂可能会作为单一药物使用。作为二线治疗,已经报道了一些治疗药物,可以考虑使用。