With the global incidence of hepatocellular carcinoma(HCC)on the rise,precise staging has become critical for guiding treatment decisions and improving long-term outcomes.The Barcelona Clinic Liver Cancer(BCLC)staging...With the global incidence of hepatocellular carcinoma(HCC)on the rise,precise staging has become critical for guiding treatment decisions and improving long-term outcomes.The Barcelona Clinic Liver Cancer(BCLC)staging system,widely used for HCC classification,incorporates factors such as Child–Pugh A or B liver function,tumor size and number,absence of cancer-related symptoms,and lack of vascular invasion or extrahepatic metastasis.For intermediate-stage HCC,transarterial chemoembolization(TACE)remains the globally recom-mended standard.However,the substantial heterogeneity in tumor burden and liver function among patients means that not all individuals benefit equally from TACE.As a result,a uniform treatment approach is insuffi-cient.Preserving liver function is now recognized as equally important as achieving high objective response rates,with the ultimate goal of prolonging overall survival.In response,researchers have proposed advanced stratification methods for stage B HCC to optimize therapeutic outcomes.While these stratification criteria remain under debate,there is a growing shift from TACE-centric strategies toward personalized targeted ther-apies for specific subpopulations.This review explores advanced stratification concepts,evaluates corresponding treatment strategies,analyzes ongoing clinical trials,and assesses their potential to transform the management of intermediate-stage HCC—while also outlining future directions for its treatment.展开更多
Hepatocellular carcinoma(HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification syste...Hepatocellular carcinoma(HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization(TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidatesfor systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies(TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.展开更多
BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B...BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B HCC patients more suitable for LR.METHODS We included patients undergoing curative LR for BCLC stage A or B multinodular HCC(MNHCC)and stratified BCLC-B patients by the sum of tumor size and number(N+S).Overall survival(OS),recurrence-free survival(RFS),recurrence-to-death survival(RTDS),recurrence patterns,and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients.RESULTS In total,143 patients who underwent curative LR for MNHCC with BCLC-A(n=25)or BCLC-B(n=118)were retrospectively analyzed.According to the N+S,patients with BCLC-B HCC were divided into two subgroups:BCLC-B1(N+S≤10,n=83)and BCLC-B2(N+S>10,n=35).Compared with BCLC-B2 patients,those with BCLC-B1 had a better OS(5-year OS rate:67.4%vs 33.6%;P<0.001),which was comparable to that in BCLC-A patients(5-year OS rate:67.4%vs 74.1%;P=0.250),and a better RFS(median RFS:19 mo vs 7 mo;P<0.001),which was worse than that in BCLC-A patients(median RFS:19 mo vs 48 mo;P=0.022).Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS(median RTDS:Not reached vs 49 mo;P=0.599),while the RTDS in BCLC-B2 patients was worse(median RTDS:16 mo vs not reached,P<0.001;16 mo vs 49 mo,P=0.042).The recurrence patterns were similar between BCLC-B1 and BCLC-A patients,but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis,both of which were independent risk factors for RTDS.CONCLUSION BCLC-B HCC patients undergoing hepatectomy with N+S≤10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients,and LR should be considered in these patients.展开更多
基金supported by Beijing Natural Science Foundation,China(L244027).
文摘With the global incidence of hepatocellular carcinoma(HCC)on the rise,precise staging has become critical for guiding treatment decisions and improving long-term outcomes.The Barcelona Clinic Liver Cancer(BCLC)staging system,widely used for HCC classification,incorporates factors such as Child–Pugh A or B liver function,tumor size and number,absence of cancer-related symptoms,and lack of vascular invasion or extrahepatic metastasis.For intermediate-stage HCC,transarterial chemoembolization(TACE)remains the globally recom-mended standard.However,the substantial heterogeneity in tumor burden and liver function among patients means that not all individuals benefit equally from TACE.As a result,a uniform treatment approach is insuffi-cient.Preserving liver function is now recognized as equally important as achieving high objective response rates,with the ultimate goal of prolonging overall survival.In response,researchers have proposed advanced stratification methods for stage B HCC to optimize therapeutic outcomes.While these stratification criteria remain under debate,there is a growing shift from TACE-centric strategies toward personalized targeted ther-apies for specific subpopulations.This review explores advanced stratification concepts,evaluates corresponding treatment strategies,analyzes ongoing clinical trials,and assesses their potential to transform the management of intermediate-stage HCC—while also outlining future directions for its treatment.
文摘Hepatocellular carcinoma(HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization(TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidatesfor systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies(TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.
基金approved by the Ethics Committee of the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology(Approval No.TJIRB20210918).
文摘BACKGROUND The selection criteria for Barcelona Clinic Liver Cancer(BCLC)intermediate-stage hepatocellular carcinoma(HCC)patients who would truly benefit from liver resection(LR)remain undefined.AIM To identify BCLC-B HCC patients more suitable for LR.METHODS We included patients undergoing curative LR for BCLC stage A or B multinodular HCC(MNHCC)and stratified BCLC-B patients by the sum of tumor size and number(N+S).Overall survival(OS),recurrence-free survival(RFS),recurrence-to-death survival(RTDS),recurrence patterns,and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients.RESULTS In total,143 patients who underwent curative LR for MNHCC with BCLC-A(n=25)or BCLC-B(n=118)were retrospectively analyzed.According to the N+S,patients with BCLC-B HCC were divided into two subgroups:BCLC-B1(N+S≤10,n=83)and BCLC-B2(N+S>10,n=35).Compared with BCLC-B2 patients,those with BCLC-B1 had a better OS(5-year OS rate:67.4%vs 33.6%;P<0.001),which was comparable to that in BCLC-A patients(5-year OS rate:67.4%vs 74.1%;P=0.250),and a better RFS(median RFS:19 mo vs 7 mo;P<0.001),which was worse than that in BCLC-A patients(median RFS:19 mo vs 48 mo;P=0.022).Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS(median RTDS:Not reached vs 49 mo;P=0.599),while the RTDS in BCLC-B2 patients was worse(median RTDS:16 mo vs not reached,P<0.001;16 mo vs 49 mo,P=0.042).The recurrence patterns were similar between BCLC-B1 and BCLC-A patients,but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis,both of which were independent risk factors for RTDS.CONCLUSION BCLC-B HCC patients undergoing hepatectomy with N+S≤10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients,and LR should be considered in these patients.
