從《原發(fā)性肝癌診療指南(2024年版)》更新看我【摘要】《原發(fā)性肝癌診療指南(2024年版)》的發(fā)布標(biāo)志著我國(guó)肝癌綜合治024年版)》[1](以下簡(jiǎn)稱“新版指南”),這是自2017年6月原國(guó)家衛(wèi)生和計(jì)劃生育委員會(huì)醫(yī)政醫(yī)管局發(fā)布《原發(fā)性肝癌診療規(guī)范(2017年版)》后，高于直徑1.0~2.0cm的小肝癌(5年生存率為89.5%)[4]。在高危人群中，排除確定的良性病變后，診斷scHCC的標(biāo)準(zhǔn)推薦GdEOB-DTPA增強(qiáng)MRI聯(lián)合增強(qiáng)MRI或增強(qiáng)CT或超聲造影[5-6],尤其對(duì)于肝硬化病人，強(qiáng)烈推薦采用該方法，1.2病理學(xué)部分hepatocellularcholangiocarcinoma,cHCC-CCA)的病理學(xué)診斷標(biāo)準(zhǔn)[8],但onse,pCR)。對(duì)于“明顯病理緩解”(majorpathologicre-spon2肝癌的臨床分期3肝癌的治療選擇當(dāng)于CNLCIIa期),首選治療通常為系統(tǒng)治3.1手術(shù)治療 國(guó)專家共識(shí)(2024版)》保持一致。對(duì)于有功能FLR不足的肝癌病人，推薦在 的FLR;相較于PVE,ALPPS具有更高的轉(zhuǎn)化效率[12]。針對(duì)腫瘤學(xué)轉(zhuǎn)化，推epaticarterialin-fusionchemotherapy,HAIC)的潛在優(yōu)勢(shì)[13]。此外，對(duì)于肝癌術(shù)后輔助治療，因?yàn)镮Mbrave050研究[14]達(dá)到了無復(fù)發(fā)3.2局部治療 3.3系統(tǒng)治療icalpracticerecommendations IUM,andFLAUS[J].UltrasoundMedBiol,2020,46(10):2579-[3]LeeJY,MinamiY,ChoiBI,etal.TheAFSUMBconsandrecommendationsfortheclinicalpracticeofcontrastenhancedultrasoundusingsonazoid[J].JMed[4]FanR,PapatheodoridisG,SunJ,etal.aMhepatocellularcarcinis[J].JHepatol,2020,73(6):1368-1378.patocellularcarcinomapredictionbasedonlongitudinaldataandcell-freeDNAsignatures[J].JHepatol,2023,79(4):93ellularcarcinomaandhigh-gradedysplasticnoduncedultrasound:correlationwrasoundMed,2020,39(9):1799-1808.adiol(NY),2023,48(6):2019-2037.[8]CongWM.Surgicalpathologre:Springer,2017:145-216.commendationsforpathologicaimensafterneoadjuvanttherapy[J].[10]AllardMA,SebaghM,RuizA,etal.Doespathologicacirrhoticpatientswithcirrhosispredictoutcomeafterliverresectionortransplantation?[J].JHepatol,2015,63(1):83-92.5patients[J].AnnSurg,2020,271(3):534-541.[12]LiPP,HuangG,JiaNY,etal.Associatinportalveinligationforstagedhepatectomyverstivestudy[J].HepatobiliarySurgNutr,2022,11(1):38-51.rialchemoembolizationasfirst-linetreatmentforallularcarcinoma:aphaseIⅢ,randomizedclinicalJClinOncol,2023,41(1):[14]QinS,ChenM,ChengAL,etal.Atezolizumabplusbevaciriskhepatocellularcarcinoma(IMbrave050):arandomised,open-label,multicentre,phase3trial[J].Lancet,2023,402(10415):1835-18ionofoxaliplatin,fluorouracil,andleucov[16]LyuN,KongY,MuL,etal.Hepaticarterialinfusionofoxalipellularcarcinoma[J].JHepato版)[J].中國(guó)醫(yī)刊，2020,55(5):489-492.[18]WeiZ,ZhaoJ,BiX,etal.Neoadjuvantablehepatocellularc [19]WeiX,JiangY,ZhangX,etal.Neoadjuvantthree-rtalveintumorthrombus:arandomized,open-label,multicentercont[20]QinS,ChanSussorafenibasfirst-linetherapyforunresectablehepatocellstudy[J].Lancet,2023,402(10408):1133-1146.st-line