The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma.
The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma.
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DOI：
10.1002/lt.20034
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发表时间：
2004-02-01
期刊：
影响因子：
--
通讯作者：
Bruix, Jordi
中科院分区：
文献类型：
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作者：
Llovet, Josep M;Fuster, Josep;Bruix, Jordi
肝细胞癌（HCC）是世界上第五大常见肿瘤，也是癌症相关死亡的第三大常见原因。它主要影响任何病因的肝硬化患者。因此，肝硬化患者通常被纳入旨在实现早期发现和有效治疗的监测计划。只有那些如果被诊断为HCC而接受治疗的患者才应该接受监测，这是基于超声检查和甲胎蛋白每6个月一次。诊断后，患者必须进行分期，以确定肿瘤范围和肝功能损害。此后，可以指示最佳治疗选项，并且可以建立预后估计。目前的手稿描述了维罗纳诊所肝癌组的诊断和治疗策略。这是基于对几项队列和随机对照研究的分析，这些研究允许不断完善治疗适应症和应用。手术切除被认为是早期患者的首选治疗方案。它被保留给没有门静脉高压和胆红素正常的孤立性肿瘤患者。如果不符合这些条件，则考虑患者进行肝移植（尸体或活体捐赠）或经皮消融（如果处于早期阶段（孤立性≤ 5 cm或多达3个结节≤ 3 cm））。这些患者的5年生存率将达到50%至75%。如果患者被诊断为中间阶段，仍然没有症状，并保留肝功能，他们可能会受益于化疗栓塞。3年生存率将超过50%。对于晚期疾病患者没有有效的治疗方法，因此，在这种情况下，必须考虑对患者进行新治疗方案的研究试验。最后，终末期疾病患者应只接受姑息治疗，以避免不必要的痛苦。
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, and the third most common cause of cancer-related death. It affects mainly patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in surveillance plans aiming to achieve early detection and effective treatment. Only patients who would be treated if diagnosed with HCC should undergo surveillance, which is based on ultrasonography and alpha-fetoprotein every 6 months. Upon diagnosis, the patients have to be staged to define tumor extent and liver function impairment. Thereafter, the best treatment option can be indicated and a prognosis estimate can be established. The present manuscript depicts the Barcelona-Clinic Liver Cancer Group diagnostic and treatment strategy. This is based on the analysis of several cohort and randomized controlled studies that have allowed the continuous refinement of treatment indication and application. Surgical resection is considered the first treatment option for early stage patients. It is reserved for patients with solitary tumors without portal hypertension and normal bilirubin. If these conditions are not met, patients are considered for liver transplantation (cadaveric or live donation) or percutaneous ablation if at an early stage (solitary < or =5 cm or up to 3 nodules < or =3 cm). These patients will reach a 5-year survival between 50 and 75%. If patients are diagnosed at an intermediate stage and are still asymptomatic and have preserved liver function, they may benefit from chemoembolization. Their 3-year survival will exceed 50%. There is no effective treatment for patients with advanced disease and thus, in such instances, the patients have to be considered for research trials with new therapeutic options. Finally, patients with end-stage disease should receive only palliative treatment to avoid unnecessary suffering.