肝细胞癌综合治疗选择与策略

肝细胞癌的治疗包括手术切除、肝动脉化疗栓塞（TACE）和局部消融等多种方法。肝脏功能和肿瘤状况是决定是否可行手术的最主要的2个因素。合并门静脉、胆管癌栓仍应积极争取手术。除手术外，肝移植和局部消融是另两种根治性治疗方法，目前一般用于符合Milan标准的早期肝癌（单发肿瘤，直径≤5cm；多发肿瘤，数目≤3个，最大直径≤3cm）。前者要求肝功能失代偿，后者要求肝功能Child—PutghA、B级且不适合手术切除。TACE是不适合根治性治疗的中晚期肝癌的首选方法，选择性的与手术、射频消融、放疗、索拉非尼联用以提高疗效。局限性肝内病灶而又不适合局部消融的肝细胞癌可使用放疗，尤其是肝外转移灶。索拉非尼目前仍主要用于晚期肝细胞癌。免疫治疗是肝细胞癌辅助治疗方法。充分了解各种治疗方法特点，把握适应证，合理综合治疗肝细胞癌，以提高肝细胞癌整体疗效。

Choice and strategy of comprehensive treatment for hepatocellular carcinoma

The treatments of hepatocellular carcinoma （HCC） include hepatectomy, transcatheter arterial chemoembolization （TACE） , partial ablation and so on. Liver function and tumor condition are of main factors for hepatectomy. For HCC patients with tumor thrombi in either the portal vein or bile duct, radical resection should also be recommended. Besides hepatectomy, liver transplantation and partial ablation are other two radical treatments, which are generally used in early HCC according to the Milan criteria （ defined as a single HCC lesion smaller than 5 cm, or 2 to 3 nodules smaller than 3 era）. Hepatic decompensation is the indication for liver transplantation, while liver function Child-Pugh A or B unsuitable for resection is the indication of partial ablation . TACE is recommended for advanced HCC patients with unresectable hepatoma. TACE could be used in combination with operation, radiofrequency ablation, radiotherapy and sorafenib. Radiotherapy could also be used for patients with limited lesions, especially those with extrahepatic metastases. Sorafenib is still mainly used for advanced HCC at present. Immunotherapy is one of the adjuvant therapies for HCC. To improve the survival of HCC patients, the characteristics and indications of comprehensive management should be understood.