IHPBA 2026年资源受限医疗环境中肝细胞癌管理全球指南。
完整摘要 · 中文译文
背景：当前针对肝细胞癌（HCC）患者的管理指南主要侧重于资源充足的医疗系统。2024年，国际肝胆胰协会（IHPBA）遗产委员会启动了一项制定全球资源敏感性肝细胞癌管理指南的进程。 方法：IHPBA全球指南小组制定并传播了关于肝细胞癌从诊断到治疗的管理声明，通过网络研讨会进行讨论并生成指南。本文件侧重于资源受限医疗环境中肝细胞癌患者的诊断与管理。 结果：初始诊断通过超声进行，并以断面影像学检查支持。建议在诊断时检测甲胎蛋白并评估肝脏合成功能。不强制要求病灶活检。对于肝功能 preserved（保留）且病灶数不超过3个、每个≤3 cm的单发肝细胞癌患者，肝切除术是推荐的治疗选择。射频消融和微波消融被认为效果相当，在无法进行切除时可使用。如果热消融不可用，可使用乙醇注射，但应限于小病灶。TACE（经动脉化疗栓塞）和TAE（经动脉栓塞）可用于中期疾病。推荐阿替利珠单抗/贝伐珠单抗联合方案作为一线全身治疗，若一线治疗不可用，则推荐索拉非尼和仑伐替尼。本文提供了针对晚期或终末期疾病患者护理的建议。 结论：本文件提供了资源敏感的肝细胞癌（HCC）指南，这些指南优先考虑可行性，最大化获益，并减少对单纯最佳支持治疗的默认依赖，是由国际肝胆胰协会（IHPBA）通过与全球IHPBA社区讨论制定的。
完整摘要 · 英文原文
BACKGROUND: Current guidelines for the management of patients with HCC are predominantly focused on well-resourced healthcare systems. In 2024, the IHPBA Legacy committee initiated a process to develop global resource-sensitive guidelines for the management of HCC. METHODS: An IHPBA global guideline group produced and circulated statements on the management of HCC from diagnosis to treatment, discussed these in online webinars and generated guidelines. This document focuses on the diagnosis and management of patients with HCC in resource-constrained healthcare settings. RESULTS: Initial diagnosis by ultrasound is supported by cross-sectional imaging. Alfa-feto protein and assessment of liver synthetic function are recommended at diagnosis. Lesion biopsy is not mandated. Liver resection is the recommended treatment of choice for single HCC in patients with preserved liver function and up to 3 lesions ≤3 cm. Radiofrequency and microwave are regarded as equivalent and can be used if resection is not available. Ethanol injection can be used if thermal ablation is not available but should be restricted to small lesions. TACE and TAE can be used for intermediate stage disease. Atezolizumab/bevacizumab combination is recommended as first line systemic therapy with sorafenib and Lenvatinib being recommended if first line is not an option. Advice for the care of the patient with advanced or terminal disease is provided. CONCLUSIONS: This document provides resource-sensitive HCC guidelines that prioritise feasibility, maximise benefit, and reduce default reliance on best supportive care alone and are produced for the IHPBA by discussion with the global community of IHPBA.