中国《原发性肝癌诊疗指南(2022年版)》与《BCLC预后预测和治疗推荐策略(2022年版)》的解读  

Interpretation of“Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer(version-2022)”and“BCLC Strategy for Prognosis Prediction and Treatment Recommendation:The 2022 update”

作　　者：朱广志[1,2,3] 严律南 彭涛[1,2,3] ZHU Guangzhi;YAN Lünan;PENG Tao(Department of Hepatobiliary Surgery,The First Affiliated Hospital,Guangxi Medical University,Nanning 530021,P.R.China;Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor,Ministry of Education,Nanning 530021,P.R.China;Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer,Nanning 530021,P.R.China;Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]广西医科大学第一附属医院肝胆外科,南宁530021 [2]区域性高发肿瘤早期防治研究教育部重点实验室,南宁530021 [3]广西消化道肿瘤加速康复外科基础研究重点实验室,南宁530021 [4]四川大学华西医院肝脏外科,成都610041

出　　处：《中国普外基础与临床杂志》2022年第4期434-439,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金资助项目(项目编号:81560535、81072321)。

摘　　要：2022年中国修订并更新形成了《原发性肝癌诊疗指南(2022年版)》(以下简称“《中国肝癌分期方案(China Liver Cancer Staging,CNLC)2022年版》”),同时巴塞罗那临床肝癌(Barcelona Clinical Liver Cancer,BCLC)分期系统也于2021年12月做了较大更新并形成《BCLC预后预测和治疗推荐策略(2022年版)》(以下简称“《BCLC 2022年版》”),笔者对这两个指南的更新内容进行了对比解读。在原发性肝癌治疗路径中,《CNLC 2022年版》与《BCLC 2022年版》对BCLC B和C期(BCLC B期相当于CNLCⅡa、Ⅱb期、BCLC C期相当于CNLCⅢa期)患者外科手术治疗的推荐度不同,而且对于CNLCⅡb和Ⅲa期肝癌患者这2个指南对放射治疗的推荐度也不同。对于晚期肝癌的系统治疗,2个指南一线用药均推荐采用阿替利珠单抗和贝伐珠单抗、仑伐替尼和索拉非尼,但《CNLC 2022年版》相对《BCLC 2022年版》更灵活,为我国肝癌患者提供了更符合中国国情的治疗选择。值得关注的是,《BCLC 2022年版》治疗路径中提出了2个重要的新概念,即治疗分期迁移和不可治疗的进展;同时提出根据肿瘤负荷和肝功能情况将BCLC B期患者分为3个亚组并推荐不同的临床路径。“Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer(version-2022)”(China Liver Cancer Staging,Abbreviation“CNLC 2022”)was updated recently and the“Barcelona Clinical Liver Cancer Strategy for Prognosis Prediction and Treatment Recommendation:The 2022 update”(Abbreviation“BCLC 2022”)was also updated in December 2021.The similarities and differences of the two guidelines were interpreted.For the BCLC stage B and C,which are equivalent to CNLC stageⅡa andⅡb and CNLC stageⅢa,respectively,the recommendation of surgical treatment and radiation therapy are disparate in the CNLC 2022 and BCLC 2022.For the systematic treatment of advanced liver cancer,Atezolizumab-Bevacizumab,Renvatinib and Sorafenib were both recommended as the first-line medication in the two guidelines.However,the CNLC 2022 is more flexible than BCLC 2022,which provides more treatment options for Chinese liver cancer patients.It is worth paying attention to two important new concepts proposed in the BCLC 2022:stage migration during treatment and untreatable progression.The BCLC stage B was divided into three subgroups according to tumor burden and liver function and different clinical pathways were recommended in the BCLC 2022.

关 键 词：原发性肝癌 指南解读 

分 类 号：R735.7[医药卫生—肿瘤]