Minimally-invasive and multidisciplinary comprehensive diagnosis and treatment for HCC: 2018 Guangzhou consensus
-
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及全身性疾病。为此,临床上需要采用包括局部治疗(如手术切除、射频消融、微波消融、化学消融、冷冻消融等)、器官水平治疗[如经导管动脉灌注化疗、经肝动脉化疗栓塞术(TACE)]和系统治疗(如免疫治疗、抗病毒治疗、分子靶向治疗等)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,凸显八大特点:(1)肝动脉造影、肝动脉造影CT、动脉-门静脉造影CT、碘化油CT、TACE-CT有助于发现更多子灶,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。
Abstract: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 and cryoablation et al),organ-level therapy(such as transcatheter arterial infusion chemotherapy and transcatheter arterial chemoembolization),and systemic therapy(such as immunotherapy,antiviral therapy and molecular targeted therapy et al). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive diagnosis and treatment of HCC,focusing on the following eight 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 or small 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 minimally-invasive therapy and surgery for early and middle stage HCC is recommended.
计量
- 文章访问数: 1509
- HTML全文浏览量: 37
- PDF下载量: 359
- 被引次数: 0