肝细胞癌诊断与治疗的新进展

StephenW

New advances in the diagnosis and management of hepatocellular carcinoma
Ju Dong Yang  1   2   3 , Julie K Heimbach  4
Affiliations
Affiliations

    1
    Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
    2
    Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
    3
    Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
    4
    Division of Transplant Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA [email protected].

    PMID: 33106289 DOI: 10.1136/bmj.m3544

Abstract

Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

StephenW

肝细胞癌诊断与治疗的新进展
朱东阳1 2 3，朱莉·海姆巴赫4
隶属关系
隶属关系

    1个
    美国加利福尼亚州洛杉矶Cedars-Sinai医学中心胃肠病学和肝病学Karsh部门。
    2
    美国加州锡达斯西奈医学中心综合移植中心。
    3
    美国加利福尼亚州洛杉矶Cedars-Sinai医学中心的Samuel Oschin综合癌症研究所。
    4
    梅奥医学院医学院移植外科，美国明尼苏达州罗切斯特市第一街200号，邮政编码55905，Heimbach.julie @ mayo.edu。

    PMID：33106289 DOI：10.1136 / bmj.m3544

抽象

肝细胞癌是世界上与癌症相关的死亡的主要原因之一。对肝硬化患者和高风险乙型肝炎病毒携带者的疾病进行双年度监测，可以早期发现癌症并进行长期长期治疗。肝超声检查和血清α甲胎蛋白是最常用的监测检查。如果在监测测试中发现可疑结果，则应进行多相计算机断层扫描或磁共振成像以确认对肝细胞癌的诊断。如果放射学检查结果不确定，可以考虑进行肝活检或重复影像学检查以确认肝细胞癌。这种疾病的管理很复杂。应由一个多学科团队对患者进行评估，治疗的选择应考虑多种因素，例如肿瘤负荷，肝功能障碍的严重程度，医疗合并症，当地专业知识和患者的偏爱。早期肝细胞癌最好通过根治性治疗进行治疗，包括切除，消融或移植。患有中期疾病的患者经常接受局部治疗。全身治疗保留给晚期疾病患者。多项积极的，III期随机对照试验已经扩大了晚期肝细胞癌的系统治疗选择，有望获得长期的效果，尤其是采用联合治疗的试验，这也可能最终对早期疾病的治疗产生影响。

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StephenW

https://www.bmj.com/content/bmj/371/bmj.m3544.full.pdf