转移性肝癌的管理策略:基于日本2021版转移性肝癌诊疗指南的探讨

Management strategies of metastatic liver cancer:interpretation of the 2021 Japan clinical practice guidelines for diagnosis and treatment of metastatic liver cancer

转移性肝癌的治疗因原发肿瘤的不同而异。肝外肿瘤肝转移的手术适应证仍存在争议,目前尚无国际公认的管理标准指南。2021年,日本肝胆胰外科学会联合日本大肠癌学会、日本癌治疗学会、日本胃癌学会、日本产科妇科学会、日本乳腺癌学会、日本胆道学会、日本胰腺学会、日本神经内分泌肿瘤研究会、罕见肿瘤研究会共10个学会共同制定并相继发布了《转移性肝癌的诊疗指南》的英文版和日文版,针对包括结直肠癌、胃癌、胃肠道间质瘤、胆管癌、卵巢癌、胰腺癌、乳腺癌以及神经内分泌肿瘤在内的8种不同肝外原发肿瘤肝转移的治疗提出了指导建议。本文就该指南中不同原发肿瘤肝转移的诊疗方案进行解读分析,以期为面临困境的临床医生提供指导。

Strategies for the treatment of metastatic liver cancer vary depending on the extrahepatic primary cancers.Surgical indications for metastatic liver cancer remain controversial.Currently,there are no internationally recognized standard clinical guidelines for the management of metastatic liver cancer.In 2021,the Japanese Society for Hepatobiliary and Pancreatic Surgery,together with the Society of Colorectal Cancer,the Japanese Society for Cancer Therapy,the Japanese Society for Gastric Cancer,the Japanese Society of Obstetrics and Gynecology,the Japanese Society of Breast Cancer,the Japanese Biliary Society,the Japanese Pancreatic Society,the Japanese Society of Neuroendocrine Oncology,and the Society for the Study of Rare Tumors,jointly formulated and released the English and Japanese versions of the Clinical Practice Guidelines for the Management of Metastatic Liver Cancer,which provided recommendations on handling metastatic liver cancer from eight different extrahepatic primary cancers,including colorectal cancer,gastric cancer,gastrointestinal stromal tumors,biliary tract cancer,ovarian cancer,pancreatic cancer,breast cancer,and neuroendocrine tumors.Here,the authors interpret the key points of the guidelines to provide instructions for clinicians in the diagnosis and treatment of metastatic liver cancer.