原发性肝癌诊疗指南(2024年版)
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Guidelines for the diagnosis and treatment of primary liver cancer (2024 edition)
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    摘要:

    2024年4月,《原发性肝癌诊疗指南(2024年版)》正式发布。该指南是在国家卫生健康委医政司领导下,在《原发性肝癌诊疗指南》编写专家委员会、国家癌症中心、国家肿瘤质控中心肝癌质控专家委员会指导下,由全国肝癌领域各学科专家学者共同参与制定。《原发性肝癌诊疗指南(2024年版)》更新的内容主要包括:外科治疗方法及理念更新;局部消融价值的客观评价;血管内介入治疗焕发新生;放射治疗进一步探索优化;系统治疗的重大突破。作为原发性肝癌的规范性指导文件,该指南与时俱进,及时反映了肝癌诊疗领域的新进展与新理念,将有力推动中国肝癌规范化诊疗水平的提升,提升我国该领域在学术界的影响力,对于未来全球肝癌诊疗规范化的影响具有更高的指导意义。

    Abstract:

    In April 2024, the "Guidelines for the diagnosis and treatment of primary liver cancer (2024 edition)" were officially released. The guidelines were developed by experts and scholars from various disciplines in the field of liver cancer across the country under the leadership of the Department of Medical Administration of the National Health Commission of the People's Republic of China and with guidance from the Expert Committee on the Compilation of Guidelines for the Diagnosis and Treatment of Primary Liver Cancer, the National Cancer Center, and the Liver Cancer Quality Control Expert Committee of the National Cancer Quality Control Center. The main updates in the "Guidelines for the diagnosis and treatment of primary liver cancer (2024 edition)" include: updates to surgical treatment methods and concepts; objective evaluation of the value of local ablation; revitalization of vascular intervention therapy; further exploration and optimization of radiotherapy; and significant breakthroughs in systemic treatment. As a normative guidance document for primary liver cancer, the guidelines keep pace with the times, timely reflecting new developments and concepts in the field of liver cancer diagnosis and treatment, which will effectively drive the elevation of standardized diagnosis and treatment levels for liver cancer in China, enhanced the influence of our country in this field within the academic community, and hold high guiding significance for the future global standardization of liver cancer diagnosis and treatment.

    表 2 Table 2
    表 1 Table 1
    图1 肝脏肿瘤标本基线取材部位示意图 A、B、C、D:分别对应肿瘤12点、3点、6点和9点时钟位的癌与癌旁肝组织交界处;E:肿瘤区域;F:近癌旁肝组织区域;G:远癌旁肝组织区域Fig.1
    图2 MVI病理分级标准Fig.2
    图3 肝癌诊断路线图 注:典型表现为动脉期(主要动脉晚期)病灶明显强化,门静脉期、延迟期或移行期强化下降,呈“快进快出”的强化方式。不典型表现为缺乏动脉期病灶强化,门静脉期、延迟期或移行期无廓清,甚至持续强化等。MRI:磁共振扫描;CT:计算机断层成像;CEUS:超声造影;EOB-MRI:肝细胞特异性对比剂(钆塞酸二钠,Gd-EOB-DTPA)增强磁共振扫描;US:超声。血液学分子标志物包括血清AFP、DCP、7个microRNA组合。AFP(+)为超过血清AFP检测正常值。Fig.3
    图4 中国肝癌临床分期与治疗路线图 注:PS为患者体能状态;CNLC为中国肝癌分期;MDT为多学科诊疗团队;TACE为经导管动脉化疗栓塞术。系统抗肿瘤治疗包括一线治疗:阿替利珠单克隆抗体+贝伐珠单克隆抗体、信迪利单克隆抗体+贝伐珠单克隆抗体类似物、甲磺酸阿帕替尼+卡瑞利珠单克隆抗体、多纳非尼、仑伐替尼、替雷利珠单克隆抗体、索拉非尼、FOLFOX4。二线治疗:瑞戈非尼、阿帕替尼、雷莫西尤单克隆抗体(血清AFP水平≥400 μg/L)、帕博利珠单克隆抗体、卡瑞利珠单克隆抗体、替雷利珠单克隆抗体。Fig.4
    表 3 Table 3
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中华人民共和国国家卫生健康委员会医政司.原发性肝癌诊疗指南(2024年版)[J].中国普通外科杂志,2024,33(4):475-530.
DOI:10.7659/j. issn.1005-6947.2024.04.001

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  • 收稿日期:2024-04-15
  • 最后修改日期:2024-04-16
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  • 在线发布日期: 2024-04-29