2019年中國肝細胞癌臨床治療指南：更新和見解

StephenW

2019 Chinese clinical guidelines for the management of hepatocellular carcinoma: updates and insights
Di-Yang Xie  1 , Zheng-Gang Ren  1 , Jian Zhou  1   2 , Jia Fan  1   2 , Qiang Gao  1
Affiliations

    PMID: 32832496 PMCID: PMC7423548 DOI: 10.21037/hbsn-20-480

Abstract

Importance: Approximately half of newly-diagnosed hepatocellular carcinoma (HCC) cases in the world occur in China, with hepatitis B virus (HBV) infection being the predominant risk factor. Recently, the guidelines for the management of Chinese HCC patients were updated.

Objective: The past decade has witnessed a great improvement in the management of hepatocellular carcinoma (HCC). This study reviews the recommendations in the 2019 Chinese guidelines and makes comparison with the practices from the Western world.

Evidence review: The updated recommendations on the surveillance, diagnosis, and treatment algorithm of HCC in the 2019 Chinese guidelines were summarized, and comparisons among the updated Chinese guidelines, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) guidelines were made.

Findings: Besides imaging and pathological diagnoses, novel biomarkers like the seven-micro-RNA panel are advocated for early diagnoses and therapeutic efficacy evaluation in the updated Chinese guidelines. The China liver cancer (CNLC) staging system, proposed in the 2017 guidelines, continues to be the standard model for patient classification, with subsequent modifications and updates being made in treatment allocations. Compared to the Barcelona Clinic Liver Cancer (BCLC) system, the CNLC staging system employs resection, transplantation, and transarterial chemoembolization (TACE) for more progressed HCC. TACE in combination with other regional therapies like ablation or with systemic therapies like sorafenib are also encouraged in select patients in China. The systemic treatments for HCC have evolved considerably since lenvatinib, regorafenib, carbozantinib, ramucirumab and immune checkpoint inhibitors (ICIs)were first prescribed as first-line or second-line agents.

Conclusions and relevances: Novel biomarkers, imaging and operative techniques are recommended in the updated Chinese guideline. More aggressive treatment modalities are suggested for more progressed HBV-related HCC in China.

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

2020 Hepatobiliary Surgery and Nutrition. All rights reserved.
Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn-20-480). The authors have no conflicts of interest to declare.

StephenW

2019年中國肝細胞癌臨床治療指南：更新和見解
謝迪揚1，任正剛1，建州1 2，賈凡1 2，高強1
隸屬關係

    PMID：32832496 PMCID：PMC7423548 DOI：10.21037 / hbsn-20-480

抽象

重要性：全世界約有一半新診斷的肝細胞癌（HCC）病例發生在中國，其中乙型肝炎病毒（HBV）感染是主要的危險因素。最近，更新了中國HCC患者管理指南。

目的：過去十年見證了肝細胞癌（HCC）管理的巨大進步。這項研究回顧了2019年中國指南中的建議，並與西方世界的做法進行了比較。

證據審查：總結了2019年中國指南中有關HCC的監測，診斷和治療算法的最新建議，並對更新後的中國指南，歐洲肝病研究協會（EASL）和美國肝病研究協會進行了比較。制定了《肝臟疾病研究》（AASLD）指南。

研究結果：除了影像學和病理學診斷，在最新的中國指南中還提倡使用新型的生物標誌物（如七微RNA）來進行早期診斷和療效評估。 2017年指南中提出的中國肝癌（CNLC）分期系統仍然是患者分類的標準模型，隨後對治療分配進行了修改和更新。與巴塞羅那臨床肝癌（BCLC）系統相比，CNLC分期系統採用切除，移植和經動脈化學栓塞（TACE）來治療進展性HCC。在中國某些患者中，還應鼓勵將TACE與消融等其他區域性療法或索拉非尼等全身性療法結合使用。自從首次將lenvatinib，regorafenib，carbozantinib，ramucirumab和免疫檢查點抑製劑（ICIs）列為一線或二線藥物以來，HCC的全身治療已經有了很大發展。

結論和相關性：在更新的中文指南中推薦了新穎的生物標誌物，影像學和手術技術。對於中國更多的乙肝相關肝癌，建議採取更積極的治療方式。

關鍵字：臨床實踐指南；診斷;肝細胞癌（HCC）；處理算法。

2020年肝膽外科和營養學。版權所有。
利益衝突聲明

利益衝突：所有作者均已填寫ICMJE統一披露表（可從http://dx.doi.org/10.21037/hbsn-20-480獲得）。作者沒有利益衝突要聲明。

StephenW

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