Table CDR62906 Adult Primary Liver Cancer Treatment/成人原发性肝癌治疗
ID Type Description_en Description_zh
w1 Word Surveillance 监控
w2 Word Prognosis--legacy 预后-后遗效应
w3 Word Ablation Techniques 消融术
w4 Word Cellular classification--legacy 细胞学分类--后遗效应
w5 Word Systemic Chemotherapy 全身化疗
w6 Word Diagnostic imaging 诊断影像学
w7 Word Surgical Resection 手术切除
w8 Word Liver Transplantation 肝移植
w9 Word Liver biopsy 肝活检
w10 Word Stage explanation--legacy 分期说明--后遗效应
p1 Phrase Okuda Staging System Okuda分期系统
p2 Phrase Treatment option overview--legacy 治疗选择概述--后遗效应
p3 Phrase Treatment by stage--legacy 不同分期的治疗--后遗效应
p4 Phrase Alpha-fetoprotein (AFP) levels 甲胎蛋白(AFP)水平
p5 Phrase adult primary liver cancer 成人原发性肝癌
p6 Phrase Liver (Hepatocellular) Cancer Screening 肝(细胞)癌的筛查
p7 Phrase Multiple tumors >5 cm 多发性肿瘤,大小超过5cm
p8 Phrase Regional lymph node metastasis 有区域淋巴结转移
p9 Phrase Histologic classification is as follows: 组织学分类如下:
p10 Phrase Table 1. Primary Tumor (T) 表1. 原发性肿瘤(T)
p11 Phrase Table 4. Anatomic Stage/Prognostic Groups 表4.解剖分期/预后分组
p12 Phrase Hepatoblastoma rarely occurs in adults 肝母细胞瘤在成人中罕见
p13 Phrase Natural History and Prognostic Factors 自然病程与预后因素
p14 Phrase Solitary tumor without vascular invasion 实体肿瘤,无血管浸润
p15 Phrase Adult Primary Liver Cancer (PDQ®): Treatment 成人原发性肝癌(PDQ®):治疗
p16 Phrase Table 2. Regional Lymph Nodes (N) 表2.区域淋巴结(N)
p17 Phrase The etiology of HCC is likely multifactorial HCC可能由多因素引起
p18 Phrase Cellular Classification of Adult Primary Liver Cancer 成人原发性肝癌的细胞学分类
p19 Phrase Barcelona Clinic Liver Cancer (BCLC) Staging System 巴塞罗那临床肝癌(BCLC)分期系统
p20 Phrase General Information About Adult Primary Liver Cancer 成人原发性肝癌的基本信息
p21 Phrase Stage Information for Adult Primary Liver Cancer 成人原发性肝癌的分期
s1 Sentence American Joint Committee on Cancer (AJCC) Staging System 美国癌症联合委员会(AJCC)分期系统
s2 Sentence Stage C and D Adult Primary Liver Cancer 成人C期、D期原发性肝癌
s3 Sentence Transarterial Embolization (TAE) and Transcatheter Arterial Chemoembolization (TACE) 经肝动脉栓塞术(TAE)与经导管肝动脉化疗栓塞术(TACE)
s4 Sentence Ablation can be achieved in the following ways: 消融术治疗可通过以下方法实现:
s5 Sentence Stage 0, A, and B Adult Primary Liver Cancer 成人0期,A期与B期原发性肝癌
s6 Sentence The natural course of advanced-stage HCC is better known 晚期HCC的自然病程则相对明确
s7 Sentence The following are main prognostic factors for HCC patients: HCC患者的主要预后相关因素如下:
s8 Sentence The lead reviewers for Adult Primary Liver Cancer Treatment are: 成人原发性肝癌治疗的主要审核人包括:
s9 Sentence Hepatic resection is controversial in patients with limited multifocal disease 对于局限性多灶肝癌的患者,行肝切除术仍有争议
s10 Sentence TNM may be useful in prognostic prediction after liver resection TNM可以用于肝切除术后的预后预测
s11 Sentence Solitary tumor with vascular invasion or multiple tumors none >5 cm 实体肿瘤伴血管浸润,或多发性肿瘤,大小均不超过5 cm
s12 Sentence The AJCC has designated staging by TNM to define liver cancer AJCC通过TNM分期定义不同的肝癌分期
s13 Sentence Expert-reviewed information summary about the treatment of adult primary liver cancer 关于成人原发性肝癌治疗的专家审核信息总结
s14 Sentence Ablation should include a margin of normal liver around the tumor 消融时应包括肿瘤周围的一部分正常肝组织
s15 Sentence Untreated patients with advanced disease usually survive less than 6 months 未接受治疗的晚期患者存活时间通常少于6个月
s16 Sentence Surgical resection can be considered for patients who present with the following: 手术切除的可用于下列情况:
s17 Sentence AFP is insufficiently sensitive or specific for use as a diagnostic assay AFP的敏感度与精确度均不足以用于诊断分析
s18 Sentence Several reports suggest that alcoholic cirrhosis is a risk factor for HCC 一些文献报道认为,酒精性肝硬化亦为HCC的危险因素
s19 Sentence Furthermore, RFA requires fewer treatment sessions than PEI to achieve comparable effects 并且在达到与PEI相同的效果时,RFA需要的疗程少
s20 Sentence RFA also achieves best results in patients with tumors smaller than 3 cm 对于肿瘤直径小于3cm的患者,RFA的治疗效果亦佳
s21 Sentence However, a meta-analysis has shown that TAE-TACE improves survival more than supportive treatment 但一项荟萃分析显示,TAE-TACE比支持性治疗更能改善生存率
s22 Sentence Those trials have been heterogeneous in terms of patient baseline demographics and treatment 这些研究在患者基线人口统计学与治疗上存在异质性
s23 Sentence Clinical use of TNM staging is limited because liver function is not considered 由于此分期未考虑患者的肝功能,其临床应用受到限制
s24 Sentence (Refer to the PDQ summary on Liver (Hepatocellular) Cancer Screening for more information.) (更多信息请参考PDQ总结:肝(细胞)癌的筛查一章)
s25 Sentence Expansion of the accepted transplantation for HCC is not supported by consistent data 对于超出标准的HCC是否可接受移植,目前尚无一致性证据
s26 Sentence In patients with liver decompensation, TAE-TACE could increase the risk of liver failure 对于肝功能失代偿的患者,使用TAE-TACE可增加肝衰竭的风险
s27 Sentence The TNM classification for staging, proposed by the AJCC, is not widely utilized AJCC提出的TNM分期法并未被广泛使用
s28 Sentence Local control success progressively diminishes as the tumor size increases beyond 3 cm 肿瘤直径超过3cm时,局部控制的成功率明显下降
s29 Sentence AFP can be elevated in intrahepatic cholangiocarcinoma and in some metastases from colon cancer 肝内胆管癌与某些结肠癌肝转移患者均可出现AFP增高
s30 Sentence The survival advantage of TAE-TACE over supportive care has been demonstrated by two trials 其中两项研究发现TAE-TACE相对于支持治疗的优势
s31 Sentence Of note, the BCLC staging system links each HCC stage to appropriate treatment modalities 值得注意的时,BCLC分期系统将每一个HCC分期与适当的治疗方案相联系
s32 Sentence If the AFP level is high, it can be used to monitor for recurrence 若AFP水平较高,可用于监测是否复发
s33 Sentence A number of randomized, controlled trials have compared TAE and TACE with supportive care 很多随机对照临床研究对比了TAE、TACE与支持性治疗的效果
s34 Sentence From a treatment perspective, HCC can be divided into the following two broad categories: 从治疗角度可以将HCC分为以下两类:
s35 Sentence Other PDQ summaries containing information related to adult primary liver cancer include the following: 其他与成人原发性肝癌相关的PDQ总结请参考:
s36 Sentence Five stages (0 and A through D) are identified based on the variables mentioned above BCLC基于以上变量将HCC分为五期(0,A到D)
s37 Sentence This study aims to definitively evaluate the role of radiation therapy for locally advanced HCC 此研究旨在确定放疗对于局灶性晚期HCC的作用
s38 Sentence This is known as the heat sink effect, which may preclude a complete tumor necrosis 这一效应又称“热沉效应”,可导致肿瘤无法完全坏死
s39 Sentence Surgical resection is usually performed in patients with localized HCC and sufficient functional hepatic reserve 当患者病灶局限且有足够的肝功能储备时,通常行手术切除
s40 Sentence More than ten classifications are used throughout the world, but no system is accepted worldwide 全球目前使用的肝癌分期方法超过十套,尚无共识
s41 Sentence Among noncurative treatment for HCC, transarterial chemoembolization and sorafenib have been shown to improve survival HCC非治愈性治疗中,经肝动脉化疗栓塞或索拉菲尼均可改善患者的生存率
s42 Sentence Only one study has suggested that DEB-TACE may offer an advantage in overall survival (OS) 只有一项研究报道了DEB-TACE可能对总生存率(OS)有利
s43 Sentence Tumor features and the factors related to functional hepatic reserve must be taken into account 分期必须考虑肿瘤的特点和肝脏储备功能
s44 Sentence The efficacy of other targeted therapy agents (e.g., sunitinib and brivanib) is currently being investigated 其他靶向治疗药物(如舒尼替尼、布利尼布)仍处于研究中
s45 Sentence At present, only 10% to 23% of HCC patients may be surgical candidates for curative-intent treatment 目前,可以接受治愈性手术的患者比例仅占所有患者的10%-23%
s46 Sentence The natural history of early tumors is poorly known because the majority of patients are treated 由于大多数患者得到治疗,早期肿瘤的自然病程尚不明确
s47 Sentence Patients with well-compensated cirrhosis can generally tolerate resection of up to 50% of their liver parenchyma 代偿良好的肝硬化患者基本可以耐受切除50%肝实质
s48 Sentence In those patients, transplantation is associated with a 5-year overall survival (OS) rate of approximately 70% 这些患者的5年总生存率(OS)约为70%
s49 Sentence HCC may occur in HCV-infected patients with bridging fibrosis even in the absence of overt cirrhosis 即便无明显肝硬化,出现桥接纤维化的HCV感染患者也可能发生HCC
s50 Sentence There is no worldwide agreement on a common treatment strategy for patients with hepatocellular carcinoma (HCC) 目前在全球对于肝细胞癌(HCC)的通用治疗方法尚未达成共识
s51 Sentence Adverse events attributed to sorafenib in both of these trials included hand-foot skin reactions and diarrhea 以上两项研究均观察到的索拉菲尼所致不良事件包括手足皮肤反应和腹泻
s52 Sentence The key prognostic factors are only partially known and vary at different stages of the disease 对于不同分期的患者,关键的预后因素不同且相关了解不足
s53 Sentence However, older reports have described 3-year survival rates of 13% to 21% without any specific treatment 然而早期有报道显示,在不接受任何特殊治疗的情况下,3年生存率为13%-21%
s54 Sentence HCC is the most common solid tumor worldwide and the third leading cause of cancer-related deaths HCC是全球最常见的实体瘤,位列肿瘤相关死亡的第三位
s55 Sentence All but 20 of the patients had a Childs-Pugh A liver disease score; 13% were women 除20人外,其他所有患者的肝硬化Child-Pugh分级均为A级;女性占所有患者的13%
s56 Sentence In those cases, the 5-year OS rate is expected to be as high as 40% to 59% 这些患者的5年OS预期高达40%-59%
s57 Sentence New classifications have been proposed in an effort to overcome the difficulties of having several staging systems 为克服多种分期系统并存带来的种种问题,人们提出了新的分期办法
s58 Sentence Best survivals are achieved when the HCC can be surgically excised (either by a transplantation or resection) HCC可被手术切除(手术切除或肝移植)时生存率最佳
s59 Sentence Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum 肿瘤直接侵犯周围器官(非胆囊)或伴脏层腹膜穿孔
s60 Sentence The finding of a mass in a liver with an elevated AFP does not automatically indicate HCC 发现肝内肿物伴AFP增高不一定提示HCC的存在
s61 Sentence Hepatitis B virus (HBV) infection and HCV infection appear to be the most significant causes of HCC worldwide 乙肝病毒(HBV)感染与HCV感染是全球HCC发病的最主要原因
s62 Sentence Estimated new cases and deaths from liver and intrahepatic bile duct cancer in the United States in 2013: 据估计,2013年,美国肝癌与肝内胆管癌新发病例与死亡病例数约为:
s63 Sentence Both local extension of tumor and extent of liver function impairment affect prognosis and guide selection of treatment 肿瘤的局部浸润与肝功能的受损程度影响预后与治疗方案选择
s64 Sentence As a result of these advances, conformal liver irradiation has become feasible in the treatment of focal HCC 保形肝照射现已用于局灶性HCC的治疗
s65 Sentence Little is known about the efficacy of sorafenib for the patient with Child B or C liver function 对于肝功能为Child B或C级的患者,索拉菲尼的疗效尚不明确
s66 Sentence Sorafenib is an oral multikinase inhibitor that prolongs survival in patients with advanced HCC and well-compensated liver function 索拉菲尼是一种口服多激酶抑制剂,可延长晚期HCC但肝功能代偿良好的的患者的生存时间
s67 Sentence No standardized treatment for a TAE approach has been determined (e.g., embolizing agent, chemotherapy agent and dose, treatment schedule) TAE尚无标准化治疗方法(如栓塞剂、化疗药物与其剂量、治疗方案)
s68 Sentence Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein 单发肿瘤或多发肿瘤,大小不限,至少累及门静脉或肝静脉的一条主要分支
s69 Sentence Close follow-up at 3-month intervals is recommended using the same technique that first documented the presence of the nodules 建议每3月进行随访,检查方法同首次记录发现结节时所使用的方法
s70 Sentence The BCLC staging classification retains its usefulness in early tumors and is currently the most accepted staging system for HCC BCLC分期系统对早期肿瘤也适用,是目前临床上最被认可的HCC分期系统
s71 Sentence Any chronic liver injury probably increases the risk of HCC. This risk seems elevated especially in patients who develop cirrhosis 所有慢性肝损伤均可增加HCC的风险,尤见于肝硬化患者
s72 Sentence Recent evidence from an American cohort has shown that BCLC staging offers better prognostic stratification power than other staging systems 一个美国队列研究的最新证据表明,相较于其他分期系统,BCLC对HCC的预后分层能力更佳
s73 Sentence The BCLC staging system attempts to overcome the limitations of previous staging systems by including variables related to the following: 现有的分期系统具有一定的局限性,为弥补这些局限性,BCLC分期系统纳入了与以下信息相关的变量:
s74 Sentence The principles of surgical resection involve obtaining a clear margin around a tumor, which may require any of the following: 手术切除的原则要求肿瘤周围手术切缘无病变,可能需要行下列手术:
s75 Sentence Several treatments for HCC are available that are associated with long-term survival, including liver transplantation, surgical resection, and ablation techniques 与长期生存率相关的几种HCC的治疗方案包括:肝移植、手术切除与射频消融术
s76 Sentence As a result, Okuda staging is unable to stratify prognosis for early-stage cancers and mostly serves to recognize end-stage cancer patients 因此,Okuda分期无法对早期肝癌的预后分层,更多用于终末期肝癌患者
s77 Sentence Liver transplantation, surgical resection, and ablation techniques offer high rates of complete responses, and a potential for cure in early HCC 肝移植、手术切除和射频消融的完全反应率较高,并且可能治愈一些早期HCC
s78 Sentence Malignant primary tumors of the liver consist of two major cell types: hepatocellular, which accounts for 90% of cases, and cholangiocarcinoma 肝脏原发性恶性肿瘤主要由两种类型的细胞组成:肝细胞癌(最多见,占90%)与胆管细胞癌
s79 Sentence The role of radiation therapy for HCC has traditionally been limited by the low dose tolerance of the liver to radiation 因肝脏对射线的耐受程度较低,放疗在HCC中可发挥的作用有限
s80 Sentence The incidence of HCC in stage IV primary biliary cirrhosis is approximately the same as in cirrhosis resulting from hepatitis C IV期原发性胆汁性肝硬化患者中HCC发病率基本与丙肝所致肝硬化的患者相当
s81 Sentence At this time, further studies are needed before sorafenib can be recommended for a patient with Child B or C cirrhosis 目前,对Child B级、C级患者是否推荐索拉菲尼仍需进一步的临床研究
s82 Sentence The relative risk of HCC is 100 (i.e., HBV carriers are 100 times more likely to develop HCC than uninfected persons) HCC的相对风险为100(即HBV携带者患HCC的概率为未感染者的100倍)
s83 Sentence The 5-year OS rates following curative resection range between 27% and 70% and depend on tumor stage and underlying liver function 治愈性切除术后,患者的5年OS在27%-70%,依具体肿瘤分期与肝功能决定
s84 Sentence Resection and transplantation achieve the best outcomes in well-selected candidates and are usually considered to be the first option for curative intent 在经过仔细挑选的患者人群中,手术切除与肝移植可以带来最佳的临床结果,通常为治愈性治疗方案的首选
s85 Sentence Studies are also ongoing to evaluate the role of sorafenib after TACE, with chemotherapy, or in the presence of more-advanced liver disease 目前还在进行的研究包括评估TACE伴化疗后索拉菲尼的疗效,或存在更晚期肝病情况下的疗效
s86 Sentence Hemochromatosis is also a significant risk factor for HCC and has an increased relative risk twenty times that of the normal population 血色素沉着症是HCC的另一大危险因素,与正常人群相比,此类患者患HCC的风险高出20倍
s87 Sentence TAE-TACE is considered for patients with nonsurgical HCC, who are also not amenable to percutaneous ablation in the absence of extrahepatic disease TAE-TACE适用于无肝外病变的、无法经皮消融或手术切除的HCC患者
s88 Sentence Of note, RFA may have higher complication rates than PEI, but both techniques are associated with lower complication rates than excision procedures 值得注意的是,RFA的并发症发生率高于PEI,但两种方法的并发症发生率均低于切除术
s89 Sentence The 1-year and 2-year survival rates of untreated patients in 25 randomized clinical trials were 10% to 72% and 8% to 50%, respectively 根据25项随机临床研究的结果,未接受治疗的情况下,患者的1年以及2年生存率分别为10%-72%与8-50%
s90 Sentence Tumors can be resected only if a sufficient amount of liver parenchyma can be spared with adequate vascular and biliary inflow and outflow 仅当能够保留足够体积的肝脏实质、充足的血供与胆汁进出通道时才可行肿瘤切除
s91 Sentence However, no study to date has followed a sufficiently large group of these patients for long enough to describe an incidence rate for HCC 然而目前尚无研究对大量此类患者进行长期随访,故无法准确描述HCC发病率
s92 Sentence It is also difficult to use this system to select treatment options because TNM staging relies on detailed histopathological examination available only after excision 这一分期对治疗选择的指导意义亦有限,因为TMN分期主要依赖详细的组织病理学检查结果,而这一结果通常在切除后才可获得
s93 Sentence Percutaneous ethanol injection (PEI) obtains good results in patients with Child-Pugh class A cirrhosis and a single tumor less than 3 cm in diameter 经皮乙醇注射(PEI)对于肝硬化Child-Pugh分级为A级且直径小于75px的单发病灶的患者效果良好
s94 Sentence The use of drug-eluting beads (DEB) for TACE has the potential of reducing systemic side effects of chemotherapy and may increase objective tumor response 药物洗脱珠(DEB)应用于TACE可降低化疗的全身副作用、提高客观肿瘤反应
s95 Sentence The obstruction of the arterial branch(es) feeding the tumor may reduce the blood flow to the tumor and result in tumor ischemia and necrosis 对供应肿瘤的动脉分支进行栓塞可以减少肿瘤血供,造成肿瘤缺血与坏死
s96 Sentence The SHARP trial ( NCT00105443 ), randomly assigned 602 patients with advanced HCC to receive either sorafenib 400 mg twice daily or a placebo SHARP临床研究(NCT00105443)将602例晚期HCC患者随机分为两组,分别接受索拉菲尼400mg或安慰剂每日两次给药
s97 Sentence Prognostic modeling in hepatocellular carcinoma (HCC) is complex because variables of two diseases--cirrhosis and cancer--are involved in as many as 80% of the cases 肝细胞癌(HCC)的预后模型难以建立,因为80%的患者同时患有不同程度的肝硬化与肝癌
s98 Sentence TAE is the most widely used primary treatment for hepatocellular carcinoma (HCC) when HCC is not amenable to curative treatment by excision or ablation 当肝细胞癌(HCC)无法经切除或消融术进行治愈性治疗时,最常见的首选治疗是TAE
s99 Sentence The annual incidence of HCC in HBV carriers is 0.5% to 1% per year in noncirrhotic patients and 2.5% per year in cirrhotic patients 对于非肝硬化的HBV携带者,HCC年发病率为0.5%-1%,而肝硬化的HBV携带者则为每年2.5%
s100 Sentence Often, patients with HCC are evaluated by a multidisciplinary team including hepatologists, radiologists, interventional radiologists, radiation oncologists, transplant surgeons, surgical oncologists, pathologists, and medical oncologists 通常对HCC患者的评估需要由多科团队共同完成,包括肝外科医师、放射科医师、介入放射科医师、肿瘤放疗科医师、移植外科医师、肿瘤外科医师、病理科医师与肿瘤内科医师
s101 Sentence These studies established a role for sorafenib in locally advanced and advanced hepatocellular cancers extending beyond the liver, which are not amenable to regional modalities 这些研究奠定了索拉菲尼在治疗局灶性晚期、和扩散超过肝脏范围的晚期HCC的地位,这些HCC均难以使用局部方法进行治疗
s102 Sentence Ablation is relatively contraindicated for lesions in close proximity to bile ducts, the diaphragm, or other intra-abdominal organs that might be injured during the ablation 消融术的相对禁忌证包括:近胆管、膈肌或其他腹腔内器官的肿瘤,否则消融术可能伤及周围器官
s103 Sentence However, the risk is highest among those patients with HCV-related established cirrhosis, which has an incidence rate of HCC of 2% to 8% per year 但明确患有HCV相关肝硬化的患者的风险最高,其HCC年发病率为2%-8%
s104 Sentence Aflatoxin B1 has also been implicated as a cofactor in the etiology of primary liver cancer in HBV carriers because it enhances the neoplastic risk threefold 黄曲霉素B1也是HBV携带者发生原发性肝癌的协同因素,将肿瘤风险提高至三倍
s105 Sentence The median OS rate was 6.5 months for the sorafenib group versus 4.2 months for the placebo group (HR, 0.68; 95% CI, 0.50–0.93; P = .014) 索拉菲尼组的OS中位数为6.5个月,安慰剂组为4.2个月(HR:0.68;95%CI:0.50-0.93;P=0.014)
s106 Sentence Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although its incidence is rising, principally in relation to the spread of hepatitis C virus (HCV) infection 肝细胞癌(HCC)在美国相对罕见,但发病率呈走高趋势,主要与因丙肝病毒(HCV)感染的扩散相关
s107 Sentence There are no large, robust, randomized studies that compare treatments considered effective for early stage disease, nor are there studies comparing these treatments with best supportive care 目前尚无大型、稳定、随机临床研究比较不同治疗对早期癌症的有效性,亦无研究比较这些治疗与最佳支持性治疗的效果
s108 Sentence Unlike most patients with solid tumors, prognosis of HCC patients is affected not only by the tumor stage at presentation but also by the underlying liver function 与其他多数实体瘤患者不同的是,HCC患者的预后不仅取决于发现时的肿瘤分期,而且与肝功能储备息息相关
s109 Sentence Aflatoxin B1 is produced by fungi of the Aspergillus species and is a common contaminant of grain, nuts, and vegetables in some parts of Asia and Africa 在亚洲与非洲的部分地区,黄曲霉菌产的黄曲霉素B1是谷物、坚果和蔬菜中常见的污染物
s110 Sentence The 5-year overall survival rates for patients with early HCC who are undergoing liver transplant or liver resection are 44% to 78% and 27% to 70%, respectively 接受肝移植或肝切除的早期HCC患者的5年总生存率分别为44%-78%与27%-70%
s111 Sentence However, the true incidence of HCC in alcoholic cirrhosis is unknown because most epidemiology reports on this subject were published before the identification of hepatitis C virus 然而酒性精肝硬化患者中的HCC发病相关流行病学研究大多发表较早,文献年代早于HCV的发现,因此其真正发病率仍不明确
s112 Sentence The Okuda staging system includes variables related to tumor burden and liver function, such as bilirubin, albumin, and ascites and has been extensively used in the past Okuda分期系统包含与肿瘤负担和肝功能相关的多个变量,例如胆红素、白蛋白和腹水,过去在临床中应用广泛
s113 Sentence In these cases, the diagnosis of HCC may be considered established without the need for a second imaging modality, even in the absence of a biopsy confirmation 这种情况下,HCC的诊断不再需要第二种影像学方法证明,甚至无需活检确诊
s114 Sentence In a single, prospective, population-based study that included 12,008 patients, the presence of anti-HCV positivity conferred a twentyfold increased risk of HCC compared with anti-HCV negative persons 一项单中心前瞻性基于人群的临床研究对12,008例患者进行分析,结果表明抗HCV抗体阳性患者患HCC的风险较阴性者高20倍
s115 Sentence In this subpopulation of patients, 5-year OS rates may be as high as 59%, and the recurrence-free survival rates may not differ significantly from treatment with hepatic resection 这一亚群患者的5年OS可高达59%,其无复发生存率较肝切除术无显著差异
s116 Sentence Ablation may be particularly useful for patients with early HCC that is centrally located in the liver and cannot be surgically removed without excessive sacrifice of functional parenchyma 消融术尤其适用于位于肝脏中心、手术切除将破坏大量有功能的肝实质的早期HCC
s117 Sentence However, recent technological developments in radiation therapy, including breathing motion management and image-guided radiation therapy, have allowed for more precise and targeted radiation therapy delivery to the liver 然而随着近年来放疗技术的进步,呼吸运动控制技术与影像介导放疗等新方法使可对肝脏进行更精确、更靶向的放疗
s118 Sentence Several phase II studies have suggested a benefit in local control and OS compared with historical controls for patients with locally advanced HCC unsuitable for standard locoregional therapies 一些II期临床研究通过比较标准局部疗法不适用的局灶性晚期HCC患者的历史数据,认为放疗可提高局部控制和OS
s119 Sentence Recently, the risk factors associated with the metabolic syndrome, including insulin resistance, hypertension, dyslipidemia, and obesity have been recognized as potential causes of nonalcoholic hepatosteatosis, cirrhosis, and HCC 近期,代谢综合征相关危险因素如胰岛素抵抗、高血压、脂代谢紊乱与肥胖等,被认为是非酒精性脂肪肝、肝硬化和HCC的潜在病因
s120 Sentence Chronic HBV infection is the leading cause of HCC in Asia and Africa, and HCV infection is the leading cause of HCC in Europe, Japan, and North America 慢性HBV感染是亚洲和非洲HCC发病的首要原因,而在欧洲、日本和北美,HCV感染则居发病原因之首
s121 Sentence At this time, there is no evidence supporting a survival benefit for patients with advanced HCC receiving systemic cytotoxic chemotherapy when compared with no treatment or best supportive care 目前尚无证据支持全身细胞毒性化疗对于晚期HCC患者相较于无治疗或最佳支持治疗提高生存获益
s122 Sentence Furthermore, when tumors are located adjacent to major vessels, the blood flow in the vessels may decrease the temperature reached when thermal ablation techniques such as RFA are used 当肿瘤临近主要血管时,血流可能降低热消融术(例如RFA)可达到的温度
s123 Sentence Liver transplantation is determined by the Milan criteria, which is defined as a single HCC lesion smaller than 5 cm, or 2 to 3 nodules smaller than 3 cm 根据米兰标准,肝移植的手术指征为:单发HCC病灶,直径小于125px;或2-3个结节,直径均小于75px
s124 Sentence However, many significant prognostic tumor factors confirmed in both surgical and nonsurgical series (e.g., unifocal or multifocal, vascular invasion, portal venous thrombosis, or locoregional lymph node involvement) are not included 然而许多外科/非外科中证实的主要肿瘤预后因素(例如单发或多发病灶、血管浸润、门静脉栓塞或局部区域淋巴结浸润)并未纳入分期
s125 Sentence After considering the location and number of tumors, and the patient's hepatic function, only 5% to 10% of liver cancer patients will prove to have localized disease amenable to resection 在确定肿瘤的位置、数量、患者的肝功能后,只有5%-10%的肝癌患者有可切除的局灶性病变
s126 Sentence For patients with liver nodules larger than 1 cm who are at risk for HCC, diagnosis should be established. The tests required to diagnose HCC may include radiology, biopsy, or both 若有HCC危险因素的患者发现了直径大于25px的肝脏结节,需要明确诊断,鉴别诊断方法包括影像学、活检或两者联合使用
s127 Sentence Selection of treatment is complex because several factors related to the underlying liver function, the extent and location of the tumor, and the general condition of the patient must be considered 临床上对治疗方案的选择较为复杂,必须考虑多种因素,包括肝脏功能、肿瘤位置与范围、患者一般情况等
s128 Sentence Liver transplantation is a potentially curative therapy for HCC and has the benefit of treating the underlying cirrhosis, but the scarcity of organ donors limits the availability of this treatment modality 肝移植是HCC的潜在治愈性疗法之一。其益处是可以同时解决患者的肝硬化问题,但器官供体的稀缺性使其临床应用有限
s129 Sentence A subsequent, similar trial conducted in 23 centers in China, South Korea, and Taiwan included 226 patients (97% with Child-Pugh A liver function) with a 2:1 randomized assignment to sorafenib versus placebo 一项后续相似的临床研究在中国、韩国和台湾的23个中心进行,共招募患者226例(97%的患者肝功能分级为Child-Pugh A级),以2:1的比例随机分为索拉菲尼和安慰剂两组
s130 Sentence The presence of arterial uptake followed by washout in a single dynamic study is highly specific (95%–100%) for an HCC of 1 to 3 cm in diameter and virtually diagnostic of HCC 一次动态循环中先是动脉吸收再出现洗脱的特点对于直径1-3cm的HCC病灶非常具有特异性(95%-100%),具有诊断价值
s131 Sentence In patients with cirrhosis, any interference with arterial blood supply may be associated with significant morbidity and is relatively contraindicated in the presence of portal hypertension, portal vein thrombosis, or clinical jaundice 对于肝硬化患者,影响肝动脉血液供应可增加合并症,故此类患者行动脉栓塞术的相对禁忌证包括:门脉高压、门静脉栓塞或临床黄疸
s132 Sentence Liver transplantation is considered if resection is precluded as a result of multiple, small, tumor nodules (≤3 nodules, each <3 cm), or if the liver function is impaired (Child-Pugh B and C class) 若小病灶较为多发(≤3个结节,直径均小于75px)而无法进行手术切除,或肝脏功能受损(Child-Pugh分级为B或C级),则可考虑行肝移植
s133 Sentence A liver biopsy may be performed when a diagnosis of HCC is not established by a dynamic imaging modality (three-phase CT or MRI) for liver nodules 1 cm or larger in high-risk patients 对于结节直径大于等于1cm的高风险患者,动态影像学(三期CT或MRI)无法确诊时,可行肝活检
s134 Sentence After 321 deaths, the median survival was significantly longer in the sorafenib group (10.7 months vs. 7.9 months on placebo; hazard ratio [HR] favoring sorafenib, 0.69; 95% confidence interval [CI], 0.55–0.87; P < .001) 321例患者死亡时,索拉菲尼组的生存时间中位数显著长于安慰剂组(分别为10.7个月与7.9个月,危险比[HR]提示索拉菲尼更优,为0.69,95%置信区间[CI]:0.55-0.87;P<0.001)
s135 Sentence The three potentially curative therapies (i.e., liver transplantation, surgical resection, and ablation techniques) are acceptable treatment options for small, single-nodule HCC in patients with well-preserved liver function. Surgery is the mainstay of HCC treatment 对于肝脏储备功能良好的患者,小型单发结节的HCC可以选择三种可能治愈的疗法(即肝移植、手术切除与射频消融术),其中以手术为主要的治疗方法
s136 Sentence When tumor excision, either by transplant or resection, is not feasible or advisable, ablation techniques may be used if the tumor can be accessed percutaneously or, if necessary, through minimally invasive or open surgery 当肝移植或手术切除方法均不可行或不建议时,如果可经皮穿刺、或必要时微创方法或开放性手术达到肿瘤部位,可使用消融术
s137 Sentence The 5-year cumulative risk of developing HCC for patients with cirrhosis ranges between 5% and 30% and depends on etiology (highest in individuals with HCV infection), region or ethnicity (highest in Asians), and stage of cirrhosis 对于肝硬化患者,发生HCC的5年累积风险在5%-30%之间,与肝硬化的病因(HCV感染者风险最高)、居住地、种族(亚洲人发病率最高)与肝硬化分期相关
s138 Sentence For lesions that are smaller than 1 cm and are detected during screening in patients at high risk for HCC, no detailed investigation is required because most of these lesions will be cirrhotic nodules rather than HCC 对于高HCC发病风险的人群,在筛查中若发现小于25px的病灶,无需进一步检查,因为此类病灶通常为肝硬化结节,而非HCC
s139 Sentence Preoperative assessment includes three-phase helical computed tomography, magnetic resonance imaging, or both to determine the presence of an extension of a tumor across interlobar planes and potential involvement of the hepatic hilus, hepatic veins, and inferior vena cava 术前评估包括三期螺旋CT、MRI或两者联合使用,以确定肿瘤是否超过叶间平面范围,是否累及肝门、肝静脉与下腔静脉
s140 Sentence In patients with cirrhosis, liver disease, or other risk factors for HCC, triple-phase, contrast-enhanced studies (dynamic computed tomography [CT]-scan or magnetic resonance imaging [MRI]) can be used to establish diagnosis of HCC for nodules larger than 1 cm 对于患有肝硬化、肝病或存在其他HCC危险因素的患者,三期增强扫描研究(动态计算机断层成像[CT]或磁共振成像[MRI])可以用于诊断直径大于25px的结节是否为HCC
s141 Sentence For patients with decompensated cirrhosis and a solitary lesion (&lt;5 cm) or early multifocal disease (≤3 lesions, ≤3 cm), the best option is liver transplantation, but the limited availability of deceased liver donors restricts the use of this approach 对于失代偿性肝硬化伴实体病灶(<5cm)或有早期多灶性肿瘤(≤3处,≤3cm)的患者,最佳的治疗选择是肝移植,然而因肝脏供体有限,肝移植的临床应用受到限制
s142 Sentence In the few randomized, controlled trials that included patients with Child-Pugh A cirrhosis, RFA proved superior to PEI in terms of rates of complete response and local recurrences; some of those studies have also shown improved OS with RFA 在少数随机对照临床研究中,肝硬化Child-Pugh分级为A级的患者使用RFA治疗的效果较PEI更佳,评估标准为完全反应率与局部复发率;其中一些研究还表明RFA与OS提高相关
s143 Sentence During the arterial phase of the study, HCC enhances more intensely than the surrounding liver because the arterial blood in the liver is diluted by venous blood that does not contain contrast, whereas the HCC contains only arterial blood 在动脉期,HCC较周围肝组织更为强化,因为肝脏的动脉血被不含对比剂的静脉血稀释,而HCC只含有动脉血
s144 Sentence If, despite the use of two imaging modalities, a nodule larger than 1 cm remains uncharacterized in a patient at high risk for HCC (i.e., with only one or no classic enhancement pattern), a liver biopsy can be considered 若两种影像学方法均无法区分大于1cm的结节性质,而患者又具有HCC的高危因素时(只有一种方法出现、或两者均未出现典型影像学特点),可以考虑肝活检
s145 Sentence Embolization agents, such as microspheres and particles, may also be administered along with concentrated doses of chemotherapeutic agents (generally doxorubicin or cisplatin) mixed with lipiodol or other emulsifying agents during chemoembolization, arterial chemoembolization, usually via percutaneous access; and TACE 在化疗栓塞、动脉化疗栓塞时,微球与颗粒等栓塞剂可以联合高浓度化疗药(多使用阿霉素和顺铂)与碘油或其他乳化剂混合给药,给药途径通常为经皮或TACE
s146 Sentence The majority of the blood supply to the normal liver parenchyma comes from the portal vein, while blood flow to the HCC comes mainly from the hepatic artery. Furthermore, HCC tumors are generally hypervascular compared with the surrounding normal parenchyma 正常肝脏实质的血供主要来源于门静脉,而HCC的血液灌注则主要来源于肝动脉,并且血供比周围的肝实质丰富
s147 Sentence Localized hepatocellular carcinomas (HCCs) that present either as a solitary mass in a portion of the liver or as a limited number of tumors (three nodules, each <3 cm in diameter) without major vascular invasion constitute approximately 30% of the HCC cases 无主要血管浸润的局灶性肝细胞癌(HCC),即肝内单发实体病灶或数量有限的多发病灶(3个结节,每个直径均小于75px)约占所有HCC的30%
s148 Sentence In the venous phase, the HCC enhances less than the surrounding liver, which is referred to as the venous washout of HCC, because the arterial blood flowing through the lesion no longer contains contrast; however, the portal blood in the liver now contains contrast 在静脉期,由于流经病灶的动脉血不再含有对比剂,而肝脏中门脉血液此时含有对比剂,故HCC的强化较周围组织低,称为HCC的静脉洗脱期
s149 Sentence If, on the other hand, a first imaging modality, such as either a contrast-enhanced CT or MRI, is not conclusive, sequential imaging with a different modality can improve sensitivity for HCC detection (from 33% to 41% for either CT or MRI to 76% for both studies when performed sequentially) without a decrease in specificity 但如果使用第一种影像学方法,例如对比剂增强CT或MRI未能得出结论,则可使用其他方法辅助诊断HCC以提高敏感度(CT与MRI分别为33%-41%,两者联合使用时为76%),同时不降低诊断的特异性
s150 Sentence According to the BCLC, patients with early-stage HCC may benefit from curative therapies (i.e., liver transplantation, surgical resection, and radiofrequency ablation techniques); those at intermediate- or advanced-disease stage may benefit from palliative treatments(i.e., transcatheter arterial chemoembolization and sorafenib); however, those at end-stage disease who have a very poor life expectancy are offered supportive care and palliation 根据BCLC分期系统,早期HCC患者可获益于治愈性治疗(即肝移植、手术切除与射频消融术);分期为中期或晚期的患者则可获益于姑息疗法(即经导管肝动脉化疗栓塞术与索拉菲尼);但预期存活时间极短的终末期患者可接受支持性与姑息性治疗