Asian Consensus Workshop Report: Expert Consensus Guideline for the Management of Intermediate and Advanced Hepatocellular Carcinoma in Asia
Asian Consensus Workshop Report: Expert Consensus Guideline for the Management of Intermediate and Advanced Hepatocellular Carcinoma in Asia
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DOI：
10.1159/000333280
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发表时间：
2011-01-01
期刊：
影响因子：
3.5
通讯作者：
Cheng, Ann-Lii
中科院分区：
文献类型：
--
作者：
Han, Kwang-Hyub;Kudo, Masatochi;Cheng, Ann-Lii
肝细胞癌（HCC）是许多亚洲国家的一种高度流行的疾病，占全球患者的80%。筛查计划提高了早期HCC的检测，并对生存率产生积极影响，但亚洲大多数HCC患者仍然存在晚期疾病。HCC的治疗结果受多个变量的影响，包括肝功能、患者的体力状态和肿瘤分期。因此，要应用多学科治疗方法进行最佳管理并不容易。目前，在亚洲，有资格接受根治性治疗（如手术或消融）的HCC患者数量有限。因此，大多数患者只适合姑息治疗。为了获得最佳管理，治疗选择由分期系统和治疗指南指导。已经提出了许多分期系统，治疗指南因地区而异。根据基于随机临床试验证据的巴塞罗那临床肝癌（BCLC）指南，仅推荐经动脉化疗栓塞（TACE）用于中期HCC，索拉非尼用于晚期HCC。然而，亚洲国家的治疗指南已经采用了其他几种治疗方式，如手术方法，肝动脉灌注化疗，外部放射治疗以及基于中晚期HCC临床经验的联合治疗。虽然TACE是中期的主要治疗方式，但总体治疗结果取决于肿瘤大小。在晚期，预后取决于肿瘤状态，例如。G.大血管侵犯或肝外扩散。因此，一个新的分期系统，代表适合亚洲肝癌患者和相应的最佳治疗算法应进一步研究使用循证数据，这将最终带来一个亚洲的共识，中晚期肝癌的管理。版权所有（C）2011 S. Karger AG，巴塞尔
Hepatocellular carcinoma (HCC) is a highly prevalent disease in many Asian countries, accounting for 80% of victims worldwide. Screening programs improve the detection of early HCC and have a positive impact on survival, but the majority of HCC patients in Asia still present with advanced stage disease. The treatment outcomes of HCC are affected by multiple variables, including liver function, performance status of the patient, and tumor stage. Therefore, it is not easy to apply a multidisciplinary therapeutic approach for optimal management. At present, limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia. Therefore, most patients are eligible for only palliative treatments. For optimal management, the treatment choice is guided by staging systems and treatment guidelines. Numerous staging systems have been proposed and treatment guidelines vary by region. According to the Barcelona Clinic Liver Cancer (BCLC) guideline based on evidence from randomized clinical trials, only transarterial chemoembolization (TACE) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC. However, treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach, hepatic arterial infusion chemotherapy, external radiation, and their combinations based on clinical experiences for intermediate and advanced stage HCC. Although TACE is the main therapeutic modality in the intermediate stage, overall therapeutic outcomes depend on the tumor size. In the advanced stage, the prognosis depends on the tumor status, e. g. major vessel invasion or extrahepatic spread. Thus, a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence-based data, which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC. Copyright (C) 2011 S. Karger AG, Basel