对中国2017年肝细胞癌治疗指南的批判性评价

StephenW

Hepatobiliary Surg Nutr. 2017 Dec;6(6):387-396. doi: 10.21037/hbsn.2017.11.01.
Critical appraisal of Chinese 2017 guideline on the management of hepatocellular carcinoma.Xie DY1, Ren ZG1, Zhou J1,2, Fan J1,2, Gao Q1.
Author information
1Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai 200032, China.2Institute of Biomedical Sciences, Fudan University, Shanghai 200032, China.

AbstractHepatocellular carcinoma (HCC) is the fourth most common and the third most lethal cancer in China. An updated version of consensus-based recommendations on the management of HCC has been recently published by a multidisciplinary group of Chinese experts including liver surgeons, hepatic oncologists, radiologists and pathologists. Major changes have been made to the diagnostic criteria. In addition to dynamic multi-detector computed tomography (CT) and magnetic resonance imaging (MRI), gadoxetic acid-enhanced MRI and contrast-enhanced ultrasound (CEUS) are added to the diagnostic imaging tests. Meanwhile, positive alpha-fetoprotein (AFP) no longer functions as a confirmatory test in nodules of 1-2 cm in diameter. For patients with chronic hepatitis B/C or cirrhosis of any cause, nodules more than 2 cm can be diagnosed with HCC based on typical features on one of the four imaging techniques, whereas nodules ≤2 cm need two typical imaging findings for diagnosis. Based on the increased evidences and clinical practices, a new staging system and treatment algorithm has been developed to be more comprehensible and suitable for use in China. Surgical resection, transplantation and local regional therapies (LRTs) are indicated for more progressed HCC in terms of tumor burden and for more diseased patients in terms of liver function in China than in western centers. Laparoscopic liver resections (LLRs) are not restricted by intrahepatic tumor locations and the volume of resected liver, provided lesions generally ≤10 cm. Future efforts involving prospective studies are essential to confirm the validity of the current Chinese guidelines for HCC.


KEYWORDS: Clinical practice guidelines; diagnosis; hepatocellular carcinoma (HCC); treatment algorithm

PMID:29312973PMCID:PMC5756765DOI:10.21037/hbsn.2017.11.01

StephenW

肝胆外科营养。 2017 Dec; 6（6）：387-396。 doi：10.21037 / hbsn.2017.11.01。
对中国2017年肝细胞癌治疗指南的批判性评价。
谢1 1，任志刚1，周1 1,2，范俭1,2，高一Q1。
作者信息

1
    复旦大学中山医院肝癌研究所癌变与癌症侵袭重点实验室，上海200032
2
    复旦大学生物医学研究所，上海200032

抽象

肝细胞癌（HCC）是中国第四大最常见和最致命的癌症。最近由包括肝外科医师，肝肿瘤科医师，放射科医师和病理学家在内的中国专家组成的多学科小组发表了关于HCC管理的基于共识的建议的更新版本。对诊断标准做了重大修改。除了动态多探头计算机断层扫描（CT）和磁共振成像（MRI），钆咯酸增强MRI和对比增强超声（CEUS）被添加到诊断成像测试。同时，阳性甲胎蛋白（AFP）不再作为直径1-2cm结节的确证试验。对于任何原因的慢性乙型肝炎或肝硬化患者，根据4种影像学技术之一的典型特征，超过2厘米的结节可以诊断为肝细胞癌，而结节≤2厘米则需要两种典型的影像学检查结果进行诊断。基于越来越多的证据和临床实践，一种新的分期系统和治疗算法已经被开发出来，使其更易于理解和适用于中国。在肿瘤负荷方面，手术切除，移植和局部区域疗法（LRTs）被指示用于更多进展的HCC，并且在中国比在西方中心的肝功能方面更多患病的患者。腹腔镜肝脏切除术（LLRs）不受肝内肿瘤位置和切除肝脏体积的限制，病灶一般≤10cm。未来的前瞻性研究工作对于确认目前中国HCC指南的有效性至关重要。
关键词：

临床实践指南;诊断;肝细胞癌（HCC）;治疗算法

结论：
    29312973
PMCID：
    PMC5756765
DOI：
    10.21037 / hbsn.2017.11.01