肝细胞癌微创与多学科综合诊疗——2018广州共识
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摘要
中国绝大多数肝癌是乙型病毒性肝炎和肝硬化长期发展的结果 ,具有富血供、多中心起源特点,早期即可侵犯门静脉小分支并发生肝内转移。因此,肝癌发生之初即是一种局部器官和全身性疾病。为此,临床上需要采用包括局部治疗[手术切除、射频消融(RFA)、微波消融(MWA)、化学消融、冷冻消融等]、器官水平治疗[经导管动脉灌注化疗(TAIC)、TACE]和系统治疗(免疫治疗、抗病毒治疗、分子靶向治疗)在内的综合治疗方案。本共识阐述肝细胞癌微创与多学科综合诊断和治疗方法,凸显八大亮点:(1)肝动脉造影、肝动脉造影CT(CTHA)、动脉-门静脉造影CT(CTAP)、碘化油CT(Lp-CT)、TACE-CT有助于发现子灶,精确分期;(2)TACE/消融作为早期肝癌首选治疗;(3)浸润型肝癌作为独立分型;(4)微创综合治疗转移淋巴结;(5)M(转移)分期细化用于指导个体化治疗和判断预后;(6)肝癌伴肝功能严重失代偿是肝移植候选标准;(7)提倡生物免疫、中医中药、抗病毒及社会心理治疗贯穿各期治疗方案;(8)建议开展早、中期肝癌微创介入治疗与外科手术多中心随机对照试验研究。
In China,the vast majority of hepatocellular carcinoma(HCC) is the result of long-term development of hepatitis B and cirrhosis. Pathologically, HCC is characterized by rich blood supply and multicenter origin, with early invasion of small branches of portal vein and intrahepatic metastasis. Therefore,HCC is not only a local organ but also a systemic disease at the beginning of its occurrence. For this reason,in clinical treatment of HCC a comprehensive treatment scheme should be adopted, including local treatment(such as surgical resection, radiofrequency ablation, microwave ablation, chemical ablation, cryoablation,etc), organ-level therapy(such as transcatheter arterial infusion chemotherapy and transcatheter arterial chemoembolization), and systemic therapy(such as immunotherapy, antiviral therapy, molecular targeted therapy et.al). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive diagnosis and treatment of HCC, focusing on the following 8 aspects:(1) hepatic arteriography, hepatic arteriography CT(CTHA), arterioportal angiography CT(CTAP), lipiodol CT(Lp-CT), TACE-CT, which are helpful in finding the lesion and making precise staging;(2) TACE/ablation should be used as the first choice of treatment for early stage HCC;(3) infiltrating HCC should be regarded as an independent type;(4)minimally-invasive comprehensive treatment of metastatic lymph nodes;(5) multi-level subdivision of M-staging used for guiding individual treatment and predicting prognosis;(6) HCC with severe hepatic decompensation is a candidate criterion for liver transplantation;(7) promotion of bio-immunotherapy,traditional Chinese medicine therapy, antiviral therapy and social psychotherapy, which should be run through all stages of treatment;(8) implementation of multicenter randomized controlled trials of minimallyinvasive therapy and surgery for early and middle stage HCC is recommended.(J Intervent Radiol, 2019, 28:610-624)
In China,the vast majority of hepatocellular carcinoma(HCC) is the result of long-term development of hepatitis B and cirrhosis. Pathologically, HCC is characterized by rich blood supply and multicenter origin, with early invasion of small branches of portal vein and intrahepatic metastasis. Therefore,HCC is not only a local organ but also a systemic disease at the beginning of its occurrence. For this reason,in clinical treatment of HCC a comprehensive treatment scheme should be adopted, including local treatment(such as surgical resection, radiofrequency ablation, microwave ablation, chemical ablation, cryoablation,etc), organ-level therapy(such as transcatheter arterial infusion chemotherapy and transcatheter arterial chemoembolization), and systemic therapy(such as immunotherapy, antiviral therapy, molecular targeted therapy et.al). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive diagnosis and treatment of HCC, focusing on the following 8 aspects:(1) hepatic arteriography, hepatic arteriography CT(CTHA), arterioportal angiography CT(CTAP), lipiodol CT(Lp-CT), TACE-CT, which are helpful in finding the lesion and making precise staging;(2) TACE/ablation should be used as the first choice of treatment for early stage HCC;(3) infiltrating HCC should be regarded as an independent type;(4)minimally-invasive comprehensive treatment of metastatic lymph nodes;(5) multi-level subdivision of M-staging used for guiding individual treatment and predicting prognosis;(6) HCC with severe hepatic decompensation is a candidate criterion for liver transplantation;(7) promotion of bio-immunotherapy,traditional Chinese medicine therapy, antiviral therapy and social psychotherapy, which should be run through all stages of treatment;(8) implementation of multicenter randomized controlled trials of minimallyinvasive therapy and surgery for early and middle stage HCC is recommended.(J Intervent Radiol, 2019, 28:610-624)
引文
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