巴塞罗那分期（参考）.pptVIP

肝癌的BCLC分期 The Barcelona-Clínic Liver Cancer (BCLC) staging system was constructed on the basis of the results obtained in the setting of several cohort studies and RCTs by the Barcelona group. This proposal is not a scoring system as it derives from the identification of independent prognostic factors in the setting of several studies, conforming a staging classification. This classification uses variables related to tumor stage, liver functional status, physical status, and cancer-related symptoms, and links the four stages described with a treatment algorithm . 肝癌的BCLC分期 In brief, patients at stage 0 with very early HCC are optimal candidates for resection. Patients at stage A with early HCC are candidates for radical therapies (resection, liver transplantation or percutaneous treatments). Patients at stage B with intermediate HCC may benefit from chemoembolization. Patients at stage C with advanced HCC may receive new agents in the setting of RCT, and patients at stage D with end-stage disease will receive symptomatic treatment. 肝癌的BCLC分期 It has been suggested that this classification is best suited for treatment guidance, and particularly to select early stage patients who could benefit from curative therapies . In that sense, it has recently been validated as the best staging system in a cohort of patients with early HCC. 肝癌的BCLC分期 优点： 　 ①这个分期系统弥补了以前分期系统仅适用于晚期HCC病人而缺乏早期HCC病人的不足。 ②该分期系统是根据疾病的范围和病人的预后将其分为不同的治疗组;另外还加入了病人的体力状态测试,能够反映肿瘤相关症状,从而有助于生存的预报。 ③被推荐的治疗流程图使得医生很容易选择病人的治疗手段。 缺点： 目前它还没有后续的相关研究来支持此种分类。 总结 总之,Okuda分期、BCLC分期、CL IP分期等适用于内科不适合手术治疗的进展期病人,以病理分析结果为基础的TNM分期及CS分期更适用于外科病人。由于HCC病人病变程度的不同和仅少数病例适合外科手术,上述两种分期方法都是需要的。 总结 2002年美国肝胆胰协会( the American Hepato - Pancreato - Biliary Association)和美国癌症联合会(AJCC)主张应用CL IP分期系统对内科病人分期,因为经过有效验证认为该系统适用于大部分病人,并且其数据也容易收集;而对于可以手术切除的病人,AJCC /U ICC分期系统( TNM分期第6版)最适合,因为该系统是建立在标准的TNM分期基础之上且亦经过有效验证,可用于手术和移植后的评价。 总结 为准确判断患者预后，理想的分期系统应考虑到肿瘤分期、肝功能储备及全身状况。当估计预期寿命时应该考虑到治疗的影响。目前，唯一能满足上述要求的分期方法是巴塞罗那临床肝