复发性肝癌诊治的几个焦点问题

Focus problems in diagnosis and treatment of recurrent hepatocellular carcinom

复发性肝癌是临床治疗肝癌病人的常见问题。目前,缺乏针对复发性肝癌的分期方案和治疗体系,缺少高水平的临床研究,在治疗上有较多争议。复发性肝癌的治疗争议主要体现在是否需要积极采用手术再切除或肝移植等创伤大的治疗手段。针对多克隆起源的复发肿瘤,临床治疗决策基本参照初发肝癌的分期和治疗体系,预后不劣于初发肿瘤。而对于短期内出现的单克隆起源的复发肿瘤,临床治疗更趋于介入、消融、放疗或靶向药物等创伤小的治疗手段。制定肝癌治疗方案必须综合考虑治疗创伤、安全性、有效性和费用等多个因素,复发性肝癌的治疗既类似于初发肝癌,又不同于初发肝癌。因此,其治疗不能完全参考初发肝癌的治疗体系。

Recurrent hepatocellular carcinoma(HCC)is acommon problem in the treatment of HCC patients.At present,there is a lack of staging and treatment system for recurrenthepatocellular carcinoma,and a lack of high-level clinicalresearch.Therefore,there is much controversy in the treatmentof recurrent hepatocellular carcinoma.The controversy ismainly focused on whether it is proper to take aggressivelyrepeated surgical resection or liver transplantation.For recurrent tumors of polyclonal origin,clinical treatmentdecisions are basically based on the staging and treatmentsystem of primary hepatocellular carcinoma,and the prognosisis not inferior to that of primary tumors.For recurrent tumorsof monoclonal origin,it tends to be less invasive,such asinterventional,ablation,radiotherapy or targeted drugs.Thetreatment strategy for hepatocellular carcinoma must considermany factors,such as trauma,safety,effectiveness and cost.Itis similar to and still a little different from that of primaryhepatocellular carcinoma.Therefore,the treatment of recurrenthepatocellular carcinoma cannot fully refer to the treatmentsystem of primary hepatocellular carcinoma.