Jiang Jianan, Cao Yinbiao, Gao Shang, Hu Yanqin, Yang Shizhong, Tang Haowen
School of Medicine, Tsinghua University, Beijing 100084, China.
Faculty of Hepato-Pancreato-Biliary Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
ILIVER. 2025 Aug 19;4(3):100187. doi: 10.1016/j.iliver.2025.100187. eCollection 2025 Sep.
With the global incidence of hepatocellular carcinoma (HCC) on the rise, precise staging has become critical for guiding treatment decisions and improving long-term outcomes. The Barcelona Clinic Liver Cancer (BCLC) staging system, widely used for HCC classification, incorporates factors such as Child-Pugh A or B liver function, tumor size and number, absence of cancer-related symptoms, and lack of vascular invasion or extrahepatic metastasis. For intermediate-stage HCC, transarterial chemoembolization (TACE) remains the globally recommended standard. However, the substantial heterogeneity in tumor burden and liver function among patients means that not all individuals benefit equally from TACE. As a result, a uniform treatment approach is insufficient. Preserving liver function is now recognized as equally important as achieving high objective response rates, with the ultimate goal of prolonging overall survival. In response, researchers have proposed advanced stratification methods for stage B HCC to optimize therapeutic outcomes. While these stratification criteria remain under debate, there is a growing shift from TACE-centric strategies toward personalized targeted therapies for specific subpopulations. This review explores advanced stratification concepts, evaluates corresponding treatment strategies, analyzes ongoing clinical trials, and assesses their potential to transform the management of intermediate-stage HCC-while also outlining future directions for its treatment.
随着全球肝细胞癌（HCC）发病率的上升，精确分期对于指导治疗决策和改善长期预后变得至关重要。广泛用于HCC分类的巴塞罗那临床肝癌（BCLC）分期系统纳入了诸如Child-Pugh A或B级肝功能、肿瘤大小和数量、无癌症相关症状以及无血管侵犯或肝外转移等因素。对于中期HCC，经动脉化疗栓塞术（TACE）仍然是全球推荐的标准治疗方法。然而，患者之间肿瘤负荷和肝功能存在很大异质性，这意味着并非所有个体都能从TACE中同等获益。因此，单一的治疗方法是不够的。现在人们认识到，保护肝功能与实现高客观缓解率同样重要，最终目标是延长总生存期。对此，研究人员提出了针对B期HCC的先进分层方法，以优化治疗效果。虽然这些分层标准仍存在争议，但正出现从以TACE为中心的策略向针对特定亚群的个性化靶向治疗的转变。本综述探讨了先进的分层概念，评估了相应的治疗策略，分析了正在进行的临床试验，并评估了它们改变中期HCC管理的潜力，同时还概述了其治疗的未来方向。
