终末期肝癌的癌治疗——黄勇慧.ppt

HCC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 * * * 恶性肿瘤分期是选择和改善治疗方法的基础。大部分分期系统是根据病人病情严重程度计算的积分方法，(如Okuda、TNM、CS、Clip、BCLC)。在这些提出的系统中， 1.对肿瘤进行准确分期有利于判定预后及指导治疗 2.HCC的准确期难度较大： -大多数患者有潜在的肝脏疾病 -患者预后的关键评价指标尚不完全明确 -不同疾病阶段的预后指标可能不同 3.治疗指南推荐较好的HCC分期系统应同时考虑2 肿瘤发展阶段 肝脏功能 患者健康状况 治疗对患者的影响 4.目前已经制定了多种分期系统,多有不足之处，如Okuda和CLIP分期中肿瘤大小均以占全肝50％为届进行评估，准确性欠佳。其中BCLC分期系统相对比较全面，覆盖了肿瘤大小、转移状态、肝功能情况、肿瘤症状，以及相应治疗建议，已逐渐广为接受。 * 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. 病例分享—— 终末期肝癌的抗癌治疗 中山一院放射介入专科 黄勇慧 中国抗癌协会2010肝癌全国调研数据 n=2,058 应用比例（%） 61.9％的肝癌患者接受介入治疗 TACE 占到介入治疗方式的91.