Is surgical resection still the treatment of choice for early hepatocellular carcinoma?

摘要

Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide, and in North America is one of only a few malignancies with an increasing incidence in recent years. Screening is recommended for all patients with cirrhosis, and for certain chronic carners of hepatitis B, in hopes that HCC can be diagnosed at an early stage where curative therapy can be offered ,The Barcelona Clinic Liver Cancer (BCLC) staging system has been recommended by the American Association for the Study of the Liver (AASLD) because it accounts for liver function, extent of tumor and patient performance status, and it links these factors to specific therapies . In the BCLC algorithm, surgical resection has been recommended for patients with very early stage HCC (BCLC stage 0) who have small tumors (<2cm), well preserved liver function [Child-Turcotte-Pugh (CTP) class A] and good performance status (PS = 0). Patients with early stage cancer (BCLC stage A) who have a single tumor or three tumors each <3 cm, should be offered surgical resection if they have a normal bilirubin and no evidence of portal hypertension. Liver transplantation is recommended for patients with a single tumor <=5 cm or three tumors each <3 cm in who impaired liver function precludes the ability to perform surgical resection ,