《2023年美国肝病学会实践指导:肝细胞癌的预防、诊断和治疗》意见要点
DOI: 10.3969/j.issn.1001-5256.2023.09.008
Key points in AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma (2023)
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摘要: 2023年5月,美国肝病学会在线发表《2023年美国肝病学会实践指导:肝细胞癌的预防、诊断和治疗》。该指导意见主要围绕肝细胞癌(HCC)的预防、诊断和治疗等方面展开,针对当前临床实践中存在的问题作出了相应的建议和指导。该指导意见提出了HCC筛查的重要性和适用人群,明确了早期HCC的诊断标准和手段,强调了手术治疗在HCC治疗中的地位和注意事项,同时也提及了HCC放疗、消融、介入和靶向治疗等其他治疗手段的使用及优缺点。此外,该实践指导还介绍了HCC随访的项目内容和频次等细节方面的问题。笔者团队对该指导意见进行摘译,系统介绍指导意见中的各类评估要点以及临床管理的相关建议,以期为HCC患者的临床管理和决策制定提供更多循证医学证据。Abstract: In May 2023, the American Association for the Study of Liver Diseases (AASLD) published AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma (2023) online. The guidance mainly focuses on the prevention, diagnosis, and treatment of hepatocellular carcinoma (HCC) and provides corresponding suggestions and guidance for the problems existing in current clinical practice. The guidance emphasizes the importance and target population of HCC screening, specifies the diagnostic criteria and methods for early HCC, highlights the role of surgical treatment and related precautions in the treatment of HCC, and mentions the use of other treatment methods (such as radiotherapy, ablation, interventional therapy, and targeted therapy) and their own advantages and disadvantages. In addition, the guidance also introduces the details of HCC follow-up, such as examination items and frequency. The author’s team makes an excerpt of this guidance and systematically introduces the various key points for evaluation and related recommendations for clinical management, in order to provide a basis for the clinical management and decision-making of HCC patients from the aspect of evidence-based medicine.
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Key words:
- Carcinoma, Hepatocellular /
- Prevention /
- Diagnosis /
- Therapeutics /
- United States /
- Consensus
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表 1 进行HCC监测的风险适用人群
Table 1. At-risk population for surveillance
适用人群 HCC发病率 高风险有必要进行监测的患者 Child-Pugh A~B级肝硬化,任何病因 每年>0.8% 乙型肝炎 丙型肝炎(病毒血症或持续性病毒学应答后) 酒精性肝硬化 非酒精性脂肪性肝炎 其他病因 Child-Pugh C级肝硬化且适合LT的患者 每年>0.8% 非肝硬化慢性乙型肝炎 每年>0.2% 来自该病流行率高的国家a且年龄>40岁的男性患者 来自该病流行率高的国家a且年龄>50岁的女性患者 来自非洲的年轻患者b 有HCC家族史的患者 PAGE-B评分≥10分的患者c 风险不足,需要使用风险分层模型/肿瘤生物标志物检查进行判断的患者 丙型肝炎和3期纤维化 每年<0.2% 不伴有肝硬化的非酒精性脂肪性肝病患者 每年<0.2% 注:a,根据AASLD的HBV指南定义为疾病流行的国家;b,鉴于其进行HCC诊断的中位年龄为46岁,建议在30岁时开始监测;c,可以考虑其他风险计算模型,然而PAGE-B评分已在西方人群的抗病毒治疗中得到验证。 -
[1] SINGAL AG, LLOVET JM, YARCHOAN M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma[J]. Hepatology, 2023. DOI: 10.1097/HEP.0000000000000466.[ Online ahead of print]