2017-2024年全球肝细胞癌治疗指南更新综述

Journal of liver cancer Pub Date : 2025-03-01 Epub Date: 2025-02-10 DOI:10.17998/jlc.2025.02.03
Hyunjae Shin, Su Jong Yu
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引用次数: 0

摘要

许多肝细胞癌(HCC)指南已经出版,并在世界范围内定期更新。HCC的管理涉及广泛的治疗选择,需要多学科的护理,导致国际社会管理实践的显著差异。为了支持HCC的标准化治疗,我们系统地评估了13项全球公认的指南和专家共识声明,其中5项来自亚洲,4项来自欧洲,4项来自美国。这些指南有相似之处,但在监测策略、治疗分配和其他建议方面存在显著差异。肿瘤生物学的地理差异(如病毒性肝炎、酒精相关肝病或代谢功能障碍相关脂肪变性肝病的流行)和现有医疗资源的差异(如器官可用性、医疗基础设施和治疗可及性)使制定普遍适用的指南复杂化。在此之前,亚洲和西方的指南之间存在着巨大的差距,特别是在治疗策略方面。然而,随着时间的推移,这些差异已经逐渐减少。目前,差异往往更多地归因于出版日期,而不是区域差异。尽管如此,亚太地区的专家仍然与巴塞罗那诊所的肝癌系统存在分歧,特别是在手术切除和局部治疗方面,这在西方的指导方针中被认为过于保守。全身治疗的进步促使这些指南不断更新。鉴于每一套指南都反映了不同的地区特点、优势和局限性,促进合作和相互补充对于解决差异和推进全球HCC治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A concise review of updated global guidelines for the management of hepatocellular carcinoma: 2017-2024.

Many guidelines for hepatocellular carcinoma (HCC) have been published and are regularly updated worldwide. HCC management involves a broad range of treatment options and requires multidisciplinary care, resulting in significant heterogeneity in management practices across international communities. To support standardized care for HCC, we systematically appraised 13 globally recognized guidelines and expert consensus statements, including five from Asia, four from Europe, and four from the United States. These guidelines share similarities but reveal notable discrepancies in surveillance strategies, treatment allocation, and other recommendations. Geographic differences in tumor biology (e.g., prevalence of viral hepatitis, alcohol-related liver disease, or metabolic dysfunction-associated steatotic liver disease) and disparities in available medical resources (e.g., organ availability, healthcare infrastructure, and treatment accessibility) complicate the creation of universally applicable guidelines. Previously, significant gaps existed between Asian and Western guidelines, particularly regarding treatment strategies. However, these differences have diminished over the years. Presently, variations are often more attributable to publication dates than to regional differences. Nonetheless, Asia-Pacific experts continue to diverge from the Barcelona Clinic Liver Cancer system, particularly with respect to surgical resection and locoregional therapies, which are viewed as overly conservative in Western guidelines. Advancements in systemic therapies have prompted ongoing updates to these guidelines. Given that each set of guidelines reflects distinct regional characteristics, strengths, and limitations, fostering collaboration and mutual complementarity is essential for addressing discrepancies and advancing global HCC care.

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