Hepatocellular carcinoma (HCC) ranks fourth in cancer-related deaths worldwide. Semiannual surveillance of the disease for patients with cirrhosis or hepatitis B virus allows for early detection with more favorable outcomes. The current underuse of surveillance programs demonstrates the need for intervention at both the patient and provider level. Mail outreach along with navigation provision has proven to increase surveillance follow-up in patients, while provider-targeted electronic medical record reminders and compliance reports have increased provider awareness of HCC surveillance. Imaging is the primary mode of diagnosis in HCC with The Liver Imaging Reporting and Data System (LI-RADS) being a widely accepted comprehensive system that standardizes the reporting and data collection for HCC. The management of HCC is complex and requires multidisciplinary team evaluation of each patient based on their preference, the state of the disease, and the available medical and surgical interventions. Staging systems are useful in determining the appropriate intervention for HCC. Early-stage HCC is best managed by curative treatment modalities, such as liver resection, transplant, or ablation. For intermediate stages of the disease, transarterial local regional therapies can be applied. Advanced stages of the disease are treated with systemic therapies, for which there have been recent advances with new drug combinations. Previously sorafenib was the mainstay systemic treatment, but the recent introduction of atezolizumab plus bevacizumab proves to have a greater impact on overall survival. Although there is a current lack of improved outcomes in Phase III trials, neoadjuvant therapies are a potential avenue for HCC management in the future.
肝细胞癌（HCC）在全球癌症相关死亡中位列第四。对肝硬化或乙型肝炎病毒感染者进行每半年一次的疾病监测，有助于早期发现并改善预后。目前监测项目的使用不足表明，需要在患者和医疗服务提供者层面进行干预。实践证明，邮件外联结合导诊服务能提高患者的监测随访率，而针对医疗提供者的电子病历提醒与依从性报告则提升了其对肝细胞癌监测的重视程度。影像学是肝细胞癌的主要诊断方式，其中肝脏影像报告与数据系统（LI-RADS）作为广泛认可的综合体系，实现了肝细胞癌报告与数据收集的标准化。肝细胞癌的治疗方案复杂，需由多学科团队根据患者意愿、疾病状态及可用医疗手段进行个体化评估。分期系统有助于确定适宜的治疗方案：早期肝细胞癌首选肝切除、移植或消融等根治性疗法；中期疾病可采用经动脉局部区域治疗；晚期疾病则以全身治疗为主，近年来新药联合方案取得显著进展。过去索拉非尼是全身治疗的主要药物，而近期阿特珠单抗联合贝伐珠单抗的疗法被证实能更显著提升总生存期。尽管目前三期临床试验中尚未显现疗效提升，但新辅助治疗未来可能成为肝细胞癌管理的潜在方向。
Hepatocellular Carcinoma: Surveillance, Diagnosis, Evaluation and Management
肿瘤(癌症)患者之家