摘要
Intermediate stage, or stage B according to Barcelona Clinic Liver Cancer classification, of hepatocellular carcinoma(HCC) comprises a heterogeneous population with different tumor burden and liver function. This heterogeneity is confirmed by the large variability of treatment choice and disease-relate survival. The aim of this review was to highlight the existing evidences regarding this specific topic. In a multidisciplinary evaluation, patients with large(> 5 cm) solitary HCC should be firstly considered for liver resection(LR). When LR is unfeasible, locoregional treatments are evaluable therapeutic options, being transarterial chemoembolization(TACE), the most used procedure. Percutaneous ablation can be an evaluable treatment for large HCC. However, the efficacy of all ablative procedures decrease as tumor size increases over 3 cm. In clinical practice, a combination treatment strategy [TACE or transarterial radioembolization(TARE)-plus percutaneous ablation] is "a priori" preferred in a relevant percentage of these patients. On the other hands, sorafenib is the treatment of choice in patients who are unsuitable to surgery and/or with a contraindication to locoregional treatments. In multifocal HCC, TACE is the first-line treatment. The role of TARE is still undefined. Surgery may have also a role in the treatment of multifocal HCC in selected cases(patients with up to three nodules, multifocal HCC involving 2-3 adjacent liver segments). In some patients with bilobar disease the combination of LR and ablative treatment may be a valuable option. The choice of the best treatment in the patient with intermediate stage HCC should be "patient-tailored" and made by a multidisciplinary team.
Intermediate stage, or stage B according to BarcelonaClinic Liver Cancer classification, of hepatocellularcarcinoma （HCC） comprises a heterogeneous populationwith different tumor burden and liver function. Thisheterogeneity is confirmed by the large variability oftreatment choice and disease-relate survival. The aimof this review was to highlight the existing evidencesregarding this specific topic. In a multidisciplinaryevaluation, patients with large （〉 5 cm） solitary HCC should be firstly considered for liver resection （LR）.When LR is unfeasible, locoregional treatments areevaluable therapeutic options, being transarterialchemoembolization （TACE）, the most used procedure.Percutaneous ablation can be an evaluable treatmentfor large HCC. However, the efficacy of all ablativeprocedures decrease as tumor size increases over 3 cm.In clinical practice, a combination treatment strategy[TACE or transarterial radioembolization （TARE）-plus percutaneous ablation] is ＂a priori＂ preferredin a relevant percentage of these patients. On theother hands, sorafenib is the treatment of choice inpatients who are unsuitable to surgery and/or witha contraindication to locoregional treatments. Inmultifocal HCC, TACE is the first-line treatment. Therole of TARE is still undefined. Surgery may have alsoa role in the treatment of multifocal HCC in selectedcases （patients with up to three nodules, multifocalHCC involving 2-3 adjacent liver segments）. In somepatients with bilobar disease the combination of LR andablative treatment may be a valuable option. The choiceof the best treatment in the patient with intermediatestage HCC should be ＂patient-tailored＂ and made by amultidisciplinary team.
