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肝细胞癌的分期和预后因素

Authors
Steven A Curley, MD, FACS
Carlton C Barnett, Jr, MD
Eddie K Abdalla, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD
Translators
杨晓波, 主治医师

引言

肝细胞癌(hepatocellular carcinoma, HCC)是一种侵袭性肿瘤，通常在慢性肝病和肝硬化的情况下发生。(参见“肝细胞癌的流行病学和病因学关联”)HCC往往在上述疾病的病程晚期诊断出，诊断后的中位生存期约为6-20个月[1]。肿瘤分期与基础肝病程度之间复杂的相互作用对可用的HCC治疗方案有决定性影响。

本专题将概述HCC分期与预后评分系统。HCC的手术和非手术治疗将单独讨论。 (参见“肝细胞癌治疗方法的概述”)

分期和预后评分系统

已提出多个预测HCC预后的系统，但尚无任何一种得到普遍采用[2-8]。基础肝病的严重程度、肿瘤大小、肿瘤向邻近结构侵袭的程度及是否有转移瘤这4种特征已被认为是生存情况的重要决定因素，上述系统可变地纳入它们[2,3,9-11]；一些系统(如，中国香港和法国预后分期系统)还纳入了体能状态[5,8]。最常用的4个系统是TNM(tumor-node-metastasis)系统、Okuda评分系统、巴塞罗那临床肝癌(Barcelona Clinic Liver Cancer, BCLC)分期系统，以及意大利肝癌计划(Cancer of the Liver Italian Program, CLIP)评分。白蛋白-胆红素(albumin-bilirubin, ALBI)分级是一种新的循证评分系统，如果得到独立验证，则在广泛治疗谱的HCC患者中，其能更客观地评估肝功能障碍严重程度。 (参见下文‘ALBI评分’)

TNM分期系统 — 美国癌症联合会(American Joint Committee on Cancer, AJCC)的TNM分期系统[与国际抗癌联盟(Union Internationale Contre le Cancer, UICC)采纳的系统相同]修订于2010年(表 1)[12]。与2002年分类一样，该系统识别了最重要的预后预测指标：肿瘤的数量，以及肿瘤内是否存在血管浸润及其程度[13,14]。然而，与2002年的分期系统相比，2010年修订版有一些再分类的调整，主要是围绕多发性HCC相较于伴主要血管浸润的HCC预后更好来进行的：

●对肝癌的分期只包含了HCC；肝内胆管癌单独分期。 (参见“胆管细胞癌的流行病学、发病机制及分型”，关于‘TNM分期’一节)

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-24.
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