肝癌：临床前沿和观点

StephenW

Gut doi:10.1136/gutjnl-2013-306627

    Recent advances in clinical practice

Hepatocellular carcinoma: clinical frontiers and perspectives

    Jordi Bruix1,2,
    Gregory J Gores3,
    Vincenzo Mazzaferro4

+ Author Affiliations

    1Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
    2Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
    3Mayo Clinic, Mayo College of Medicine, Rochester, Minnesota, USA
    4Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS (National Cancer Institute), Milan, Italy

    Correspondence to Dr Jordi Bruix, BCLC Group, Liver Unit, Hospital Clínic, C/Villarroel 170, Barcelona 08036, Spain; [email protected]

    Received 17 December 2013
    Revised 3 January 2014
    Accepted 19 January 2014
    Published Online First 14 February 2014

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death and is currently the main event leading to death in patients with cirrhosis. Evolving information suggests that the metabolic syndrome with non-alcoholic liver disease may be an important cause of HCC in addition to viral hepatitis and alcohol-induced liver disease. The molecular pathogenesis is extremely complex and heterogeneous. To date the molecular information has not impacted on treatment decisions. Periodic surveillance imaging of patients with cirrhosis is widely practiced, especially because diagnostic, radiographic criteria for early-stage HCC have been defined (including nodules between 1 and 2 cm) and effective treatment is available for tumours detected at an early stage. Worldwide the approach to resection versus transplantation varies depending upon local resources, expertise and donor availability. The criteria for transplantation are discussed, and the controversial areas highlighted with evidence-based recommendations provided. Several approaches are available for intermediate stage disease, including radiofrequency ablation, transarterial chemoembolisation and radioembolisation; the rationale for these therapies is buttressed by appropriate outcome-based studies. For advanced disease, systemic therapy with sorafenib remains the option best supported by current data. Thus, while several trials have failed to improve the benefits of established therapies, studies assessing the sequential or combined application of those already known to be beneficial are needed. Also, new concepts are provided in regards to selecting and stratifying patients for second-line studies, which may help explain the failure of prior studies.

StephenW

肠道DOI ： 10.1136/gutjnl-2013-306627

    在临床实践中的最新进展

肝癌：临床前沿和观点

    霍尔迪Bruix1 ，2，
    格雷戈里Ĵ Gores3 ，
    文森佐Mazzaferro4

+作者所属机构

    1Barcelona临床肝癌（ BCLC ）组，肝单位，医院诊所巴塞罗那， IDIBAPS ，巴塞罗那，西班牙巴塞罗那大学
    2Centro德INVESTIGACION BIOMEDICA恩红德Enfermedades Hepáticas Ÿ Digestivas （ CIBERehd ） ，西班牙
    3Mayo诊所，医学，罗切斯特，美国明尼苏达州的梅奥学院
    4Gastrointestinal外科和肝移植，因诺琴蒂基金会Nazionale大街Tumori IRCCS （美国国家癌症研究所） ，米兰，意大利

    对应到博士霍尔迪Bruix ， BCLC组，清肝单位，医院诊所，C /比利亚罗埃尔170 ， 08036巴塞罗那，西班牙; [email protected]

    收到二○一三年十二月十七日
    经修订的2014年1月3日
    接受2014年1月19日
    发布时间线上第一版2014年2月14日

摘要

肝细胞癌（HCC ）是癌症相关死亡的主要原因之一，是目前国内主要的事件导致死亡的肝硬化患者。不断发展的信息表明，代谢综合征与非酒精性肝病可能是肝癌除了病毒性肝炎和酒精性肝病的一个重要原因。分子发病机制极其复杂和异构的。迄今为止，分子信息并未影响到治疗的决定。肝硬化患者的定期监视成像被广泛应用，特别是因为诊断，放射学标准早期肝癌已被定义（包括1和2厘米之间结节）和有效的治疗是可在早期阶段检测到的肿瘤。全球的方法来切除与移植的变化取决于当地的资源，专业知识和捐助可用性。该标准用于移植进行了讨论，并在有争议的领域强调了与提供的证据为基础的建议。有几种方法可用于中间阶段的疾病，包括射频消融， transarterial化学栓塞和radioembolisation ，因为这些疗法的基本原理是通过适当的结果为基础的研究挟着。对于晚期患者，全身治疗与索拉非尼仍然由目前的数据支持最好的选择。因此，尽管几次试验都失败了，以提高建立的疗法的益处，还需要研究评估那些已经知道是有利的顺序或组合应用。此外，新的概念，提供了关于选择和患者分层二线的研究，这可能有助于解释以往研究的失败。