金保;杜顺达;毛一雷;桑新亭;
JIN Bao;DU Shunda;MAO Yilei;SANG Xinting;Department of Hepatic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医院肝脏外科

摘要(Abstract)：

自《原发性肝癌诊疗规范(2019年版)》发布以来，国内外在肝癌诊治领域涌现出许多新的循证医学高级别证据，尤其是多项符合中国肝癌患者诊疗的研究成果相继发表。为进一步规范我国肝癌诊疗行为，国家卫生健康委员会组织全国肝癌领域的多学科专家，更新并发布了《原发性肝癌诊疗指南(2022年版)》,旨在实现《“健康中国2030”规划纲要》提出的2030年总体癌症5年生存率提高15%的目标。本文将对2022年版指南的主要更新要点进行解读，以期推动新版指南的广泛传播与实施。
Since the publication of the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer(2019 Edition),many new high-level evidence in line with evidence-based medicine has emerged in the diagnosis and treatment of liver cancer at home and abroad, especially, a number of research results in line with Chinese liver cancer patients have been published. In order to further standardize the diagnosis and treatment of liver cancer in China, the National Health Commission organized multidisciplinary experts in the field of liver cancer to revise and update the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer(2022 Edition),aiming to increase the overall cancer 5-year survival rate by 15%,a goal mentioned in the “Healthy China 2030” Planning Outline. We interpret the main update points of the 2022 version, with the hope of promoting the widespread discussion and dissemination of the new version.

关键词(KeyWords)： 原发性肝癌;诊疗;指南;更新;解读
primary liver cancer;diagnosis and treatment;guidelines;update;interpretation

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81972698)~~

作者(Authors): 金保;杜顺达;毛一雷;桑新亭;
JIN Bao;DU Shunda;MAO Yilei;SANG Xinting;Department of Hepatic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1] Zheng RS,Zhang SW,Zeng HM,et al.Cancer incidence and mortality in China,2016[J].J Natl Cancer Cent,2022,2:1- 9.
• [2] Sung H,Ferlay J,Siegel RL,et al.Global Cancer Statistics 2020:GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J].CA Cancer J Clin,2021,71:209- 249.
• [3] 中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肿瘤学杂志，2011,16:929- 946.
• [4] 中华人民共和国卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版)[J].中国实用外科杂志，2017,37:705- 720.
• [5] 中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗规范(2019年版)[J].中华消化外科杂志，2020,19:1- 20.
• [6] 中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗指南(2022年版)[J].中华消化外科杂志，2022,21:143- 168.
• [7] 中共中央国务院.《“健康中国2030”规划纲要》[EB/OL].(2016- 10- 25)[2022- 05- 01].http://www.gov.cn/zhengce/2016- 10/25/content_5124174.htm.
• [8] Guyatt G,Oxman AD,Akl EA,et al.GRADE guidelines:1.Introduction-GRADE evidence profiles and summary of findings tables[J].J Clin Epidemiol,2011,64:383- 394.
• [9] Balshem H,Helfand M,Schunemann HJ,et al.GRADE guidelines:3.Rating the quality of evidence[J].J Clin Epidemiol,2011,64:401- 406.
• [10] Andrews JC,Schunemann HJ,Oxman AD,et al.GRADE guidelines:15.Going from evidence to recommendation-determinants of a recommendation's direction and strength[J].J Clin Epidemiol,2013,66:726- 735.
• [11] Durieux N,Vandenput S,Pasleau F.OCEBM levels of evidence system[J].Rev Med Liege,2013,68:644- 649.
• [12] Zhang BH,Yang BH,Tang ZY.Randomized controlled trial of screening for hepatocellular carcinoma[J].J Cancer Res Clin Oncol,2004,130:417- 422.
• [13] Fan R,Papatheodoridis G,Sun J,et al.aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis[J].J Hepatol,2020,73:1368- 1378.
• [14] Johnson PJ,Pirrie SJ,Cox TF,et al.The detection of hepatocellular carcinoma using a prospectively developed and validated model based on serological biomarkers[J].Cancer Epidemiol Biomarkers Prev,2014,23:144- 153.
• [15] Best J,Bechmann LP,Sowa JP,et al.GALAD Score Detects Early Hepatocellular Carcinoma in an International Cohort of Patients With Nonalcoholic Steatohepatitis[J].Clin Gastroenterol Hepatol,2020,18:728- 735.e4.
• [16] Caviglia GP,Abate ML,Petrini E,et al.Highly sensitive alpha-fetoprotein,Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein and des-gamma-carboxyprothrombin for hepatocellular carcinoma detection[J].Hepatol Res,2016,46:E130-E135.
• [17] Berhane S,Toyoda H,Tada T,et al.Role of the GALAD and BALAD- 2 Serologic Models in Diagnosis of Hepatocel-lular Carcinoma and Prediction of Survival in Patients[J].Clin Gastroenterol Hepatol,2016,14:875- 886.e6.
• [18] Huang C,Fang M,Xiao X,et al.Validation of the GALAD model for early diagnosis and monitoring of hepatocellular carcinoma in Chinese multicenter study[J].Liver Int,2022,42:210- 223.
• [19] Wang Y,Tian Y.miRNA for diagnosis and clinical implications of human hepatocellular carcinoma[J].Hepatol Res,2016,46:89- 99.
• [20] Zhou J,Yu L,Gao X,et al.Plasma microRNA panel to diagnose hepatitis B virus-related hepatocellular carcinoma[J].J Clin Oncol,2011,29:4781- 4788.
• [21] Sheng X,Ji Y,Ren GP,et al.A standardized pathological proposal for evaluating microvascular invasion of hepatocellular carcinoma:a multicenter study by LCPGC[J].Hepatol Int,2020,14:1034- 1047.
• [22] Zhang X,Li J,Shen F,et al.Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma[J].J Gastroenterol Hepatol,2018,33:347- 354.
• [23] Park JW,Chen M,Colombo M,et al.Global patterns of hepatocellular carcinoma management from diagnosis to death:the BRIDGE Study[J].Liver Int,2015,35:2155- 2166.
• [24] 中国抗癌协会肝癌专业委员会转化治疗协作组.肝癌转化治疗中国专家共识(2021版)[J].中华消化外科杂志，2021,20:600- 616.
• [25] Kaseb AO,Hasanov E,Cao HST,et al.Perioperative nivolumab monotherapy versus nivolumab plus ipilimumab in resectable hepatocellular carcinoma:a randomised,open- label,phase 2 trial[J].Lancet Gastroenterol Hepatol,2022,7:208- 218.
• [26] Shi HY,Wang SN,Wang SC,et al.Preoperative transarterial chemoembolization and resection for hepatocellular carcinoma:a nationwide Taiwan database analysis of long- term outcome predictors[J].J Surg Oncol,2014,109:487- 493.
• [27] Zhou WP,Lai EC,Li AJ,et al.A prospective,randomized,controlled trial of preoperative transarterial chemoembolization for resectable large hepatocellular carcinoma[J].Ann Surg,2009,249:195- 202.
• [28] Singal AG,Lim JK,Kanwal F.AGA Clinical Practice Update on Interaction Between Oral Direct-Acting Antivirals for Chronic Hepatitis C Infection and Hepatocellular Carcinoma:Expert Review[J].Gastroenterology,2019,156:2149- 2157.
• [29] Sapena V,Enea M,Torres F,et al.Hepatocellular carcinoma recurrence after direct-acting antiviral therapy:an individual patient data meta-analysis[J].Gut,2022,71:593- 604.
• [30] Kulik L,Heimbach JK,Zaiem F,et al.Therapies for patients with hepatocellular carcinoma awaiting liver transplantation:A systematic review and meta-analysis[J].Hepatology,2018,67:381- 400.
• [31] Lee S,Kim KW,Song GW,et al.The Real Impact of Bridging or Downstaging on Survival Outcomes after Liver Transplantation for Hepatocellular Carcinoma[J].Liver Cancer,2020,9:721- 733.
• [32] Mazzaferro V,Citterio D,Bhoori S,et al.Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL):a randomised,controlled,phase 2b/3 trial[J].Lancet Oncol,2020,21:947- 956.
• [33] Mehta N,Guy J,Frenette CT,et al.Excellent Outcomes of Liver Transplantation Following Down-Staging of Hepatocellular Carcinoma to Within Milan Criteria:A Multicenter Study[J].Clin Gastroenterol Hepatol,2018,16:955- 964.
• [34] Nordness MF,Hamel S,Godfrey CM,et al.Fatal hepatic necrosis after nivolumab as a bridge to liver transplant for HCC:Are checkpoint inhibitors safe for the pretransplant patient?[J].Am J Transplant,2020,20:879- 883.
• [35] Gao Q,Anwar IJ,Abraham N,et al.Liver Transplantation for Hepatocellular Carcinoma after Downstaging or Bridging Therapy with Immune Checkpoint Inhibitors[J].Cancers (Basel),2021,13:6307.
• [36] Qu S,Worlikar T,Felsted AE,et al.Non-thermal histotripsy tumor ablation promotes abscopal immune responses that enhance cancer immunotherapy[J].J Immunother Cancer,2020,8:e000200.
• [37] Greten TF,Mauda-Havakuk M,Heinrich B,et al.Combined locoregional-immunotherapy for liver cancer[J].J Hepatol,2019,70:999- 1007.
• [38] Mizukoshi E,Yamashita T,Arai K,et al.Enhancement of tumor-associated antigen-specific T cell responses by radiofrequency ablation of hepatocellular carcinoma[J].Hepatology,2013,57:1448- 1457.
• [39] Slovak R,Ludwig JM,Gettinger SN,et al.Immuno-thermal ablations-boosting the anticancer immune response[J].J Immunother Cancer,2017,5:78.