巴塞罗那肝癌分期系统中肝癌患者的肝动脉化疗栓术

Transcatheter Arterial Chemoembolization of Patients with Hepatocellular Carcinoma in the Staging System of Barcelona

肝细胞癌(HCC)是主要发生在肝硬化患者中的第五大常见癌症,需要分期系统来设计治疗。巴塞罗那诊所肝癌分期系统(BCLC)是最常用的肝癌治疗指南。对于BCLC B期(中间HCC),动脉化疗栓塞(TACE)是标准治疗。许多研究支持在早期和晚期HCC患者中使用TACE。对于BCLC 0期(非常早期的HCC),TACE可能是不适合射频消融(RFA)或肝切除术的患者的替代方案。在BCLC A期的患者中,TACE加RFA单独提供比RFA更好的局部肿瘤控制。TACE可作为等待肝移植患者的桥梁治疗。对于BCLC B期患者,与支持治疗方案相比,TACE提供了生存益处。然而,由于现阶段患者群体存在很大的异质性,因此需要更好的患者分层系统来选择TACE的最佳候选者。索拉非尼代表BCLC C期HCC患者的一线治疗。索拉非尼加TACE显示出延缓肿瘤进展的明显效果。另外,TACE加放疗在HCC患者和门静脉血栓形成患者中获得更好的生存。考虑到这些观察结果,TACE在HCC的每个阶段中作为独立或联合治疗在治疗HCC中显然具有关键作用。应将不同的治疗方式用于HCC患者,并应开发更好的患者分层系统,以选择TACE的最佳候选者。

Hepatocellular carcinoma （ HCC ）, the fifth most common cancer that predominantly occurs in liver cirrhosis patients, requires staging systems to design treatments.The barcelona clinic liver cancer staging system （ BCLC ） is the most commonly used HCC management guideline.For BCLC stage B （ intermediate HCC ）, transarterial chemoemholization （ TACE ） is the standard treatment.Many studies support the use of TACE in early and advanced HCC patients.For BCLC stage 0 （ very early HCC ）, TACE could be an alternative for patients unsuitable for radiofrequency ablation （ RFA ） or hepatic resection.In patients with BCLC stage A, TACE plus RFA provides better local tumor control than RFA alone.TACE can serve as bridge therapy for patients awaiting liver transplantation.For patients with BCLC B, TACE provides survival benefits compared with supportive care options.However, because of the substantial heterogeneity in the patient population with this stage, a better patient stratification system is needed to select the best candidates for TACE.Sorafenib represents the first line treatment in patients with BCLC C stage HCC.Sorafenib plus TACE has shown a demonstrable effect in delaying tumor progression.Additionally, TACE plus radiotherapy has yielded better survival in patients with HCC and portal venous thrombosis.Considering these observations together, TACE clearly has a critical role in the treatment of HCC as a stand-alone or combination therapy in each stage of HCC.Diverse treatment modalities should be used for patients with HCC and a better patient stratification system should be developed to select the best candidates for TACE.