中国肝癌的治疗现状-青岛资料.ppt

* * * * 肝癌的治疗中，过半患者接受了介入治疗，其中主要为TACE治疗； 采取手术治疗肝内病灶者亦占不小比例。 治疗方法 例数 总数 百分比 手术治疗 1037 2201 50.38 治疗原发灶 1030 2169 50.05 治疗转移灶 28 2029 放射治疗 33 1850 1.60 治疗原发灶 20 治疗转移灶 17 介入治疗 1274 2201 61.90 TAI 112 TAE 59 TACE 1165 2067 56.61/91.44 TIPS 6 支架 29 经皮局部消融治疗 222 2201 10.79 射频消融 139 微波消融 51 冷冻消融 4 化学消融 62 超声聚焦刀消融 5 全身性药物治疗 220 2018 10.69 * * * * * * Title: Current strategy for staging and treatment: the BCLC update and future prospects. Abstract: Staging and treatment indication are relevant topics in the management of patients with hepatocellular carcinoma (HCC) and for optimal results, they have to take into account liver function, tumor stage, and physical status. For any staging system to be meaningful it has to link staging with treatment indication; this should be based on robust scientific data. Currently, the sole proposal that serves both aims is the Barcelona Clinic Liver Cancer (BCLC) approach. It takes into account the relevant parameters of all important dimensions and divides patients into very early/early, intermediate, advanced, and end-stage. Early-stage HCC patients should be considered for potentially curative options such as resection, ablation, and transplantation. Patients at intermediate stage benefit from chemoembolization, whereas patients at an advanced stage, or who cannot benefit from options of higher priority, have sorafenib as the standard treatment. Finally, patients at end-stage should merely receive palliative care. 索拉非尼400mg bid 安慰剂 研究设计 入组标准 不可切除、多结节肝癌 Child-Pugh A，无腹水或肝性脑病 ECOG PS = 0 排除标准 血管侵犯、肝外转移（VI/EHS） 计划行肝移植 靶病灶曾经接受过局部治疗 既往TACE或全身治疗 随 机 主要终点 至疾病进展时间 (中心影像学评估) 次要终点 总生存期 至VI/EHS的时间 安全性 1 3 5 7 9 11 13 15 17 19 TACE (可选的) 影像 周期数 (=4周) n=307 n=154 n=153 在开始使用索拉非尼或安慰剂后的3–7天进行第一次DEBDOX-TACE治疗 然后分别在周期3、7和13的第1天（ ±4天）进行DEBDOX-TACE治疗，之后每6个周期进行一次 如果研究者认为有必要，患者可以在周期7和周期13之间、周期13和周期19之间接受额外的DEBDOX-TACE治疗 全球多中心、前瞻性、双盲、 Ⅱ期随机对照试验 整体人群疾病进展风险﹡降低20.3% 2012 Gastrointestinal Cancers Symp