2023年第2版NCCN肝细胞癌临床实践指南解读

doi:10.16139/j.1007-9610.2024.02.02

摘要/Abstract

摘要：

美国国家综合癌症网络（NCCN）作为肿瘤领域世界权威性非盈利联盟组织，每年持续更新多种恶性肿瘤的临床实践指南，已成为全球肿瘤学临床实践指南的基准。目前NCCN肝细胞癌（HCC）临床实践指南已更新至2023年V2版，与2023年V1版相比，主要是讨论部分内容的更新。从2023.V1版开始，NCCN将HCC与胆管癌的临床实践指南拆分，更新主要集中于肿瘤筛查、诊断、手术、辅助治疗、局部治疗、系统治疗等方面，并首次新增分子检测。故在2023.V2版中将2023.V1版的更新再次着重列出。本文就最新指南和这两版的更新内容进行重点解读。

关键词: 肝细胞癌, 美国国家综合癌症网络, 指南, 更新

Abstract:

The National Comprehensive Cancer Network (NCCN), as the world's leading non-profit consortium in the field of oncology, continues to update clinical practice guidelines for multiple malignancies annually and has become a benchmark for clinical practice guidelines in oncology worldwide. Currently, the NCCN clinical practice guidelines for hepatocellular carcinoma have been updated to version 2.2023, as compared with version 1.2023 of its main updates for the content of the discussion section. The NCCN guidelines for hepatobiliary cancers have been reorganized to separate guidelines for biliary tract cancers and hepatocellular carcinoma since version 1.2023. The main updates focus on tumor screening, diagnosis, surgery, adjuvant therapy, locoregional therapy, systemic therapy, and so on. The molecular testing was added for the first time. Therefore, the updates of version 1.2023 were highlighted again in the new version 2.2023. This article interpreted the new guidelines and focused on the aspects of updates.

Key words: Hepatocellular carcinoma, National Comprehensive Cancer Network(NCCN), Guidelines, Update

中图分类号:

R735.7

施纯朝, 王葵. 2023年第2版NCCN肝细胞癌临床实践指南解读[J]. 外科理论与实践, 2024, 29(02): 99-105.

SHI Chunchao, WANG Kui. Interpretation of NCCN clinical practice guidelines for hepatocellular carcinoma, version 2.2023[J]. Journal of Surgery Concepts & Practice, 2024, 29(02): 99-105.

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一线系统治疗
优先推荐方案	其他推荐方案	特定情况下有用方案
阿替利珠单抗+贝伐珠单抗（仅适用于肝功能Child-Pugh A级；1类证据）；替西木单抗（tremelimumab）+度伐利尤单抗（1类证据）。	索拉非尼[肝功能为Child-Pugh A级（1类证据）或B7级]；仑伐替尼（lenvatinib）（仅适用于肝功能Child-Pugh A级，1类证据）；度伐利尤单抗（1类证据）；帕博利珠单抗（2B类证据）。	纳武利尤单抗（仅适用于肝功能Child-Pugh B级）；阿替利珠单抗+贝伐珠单抗（仅适用于肝功能Child-Pugh B级）；纳武利尤单抗+伊匹木单抗（适用于TMB-H肿瘤，2B类证据）。
二线系统治疗
可选方案	其他推荐方案	特定情况下有用方案
瑞戈非尼（regorafenib）（仅适用于肝功能Child- Pugh A级，1类证据）；卡波替尼（cabozantinib)（仅适用于肝功能Child- Pugh A级，1类证据）；仑伐替尼（仅适用于肝功能Child-Pugh A级）；索拉非尼（sorafenib)（肝功能Child-Pugh A级或B7级）。	纳武利尤单抗+伊匹木单抗（仅适用于肝功能Child-Pugh A级）；帕博利珠单抗（仅适用于肝功能Child-Pugh A级）。	雷莫芦单抗（仅适用于AFP≥400 μg/L且肝功能Child-Pugh A级，1类证据）；纳武利尤单抗（适用于肝功能Child-Pugh B级）；多塔利单抗（dostarlimab）（适用于MSI-H/错配修复缺陷(deficiency mismatch repair, dMMR)肿瘤，2B类证据）；塞尔帕替尼（selpercatinib）（适用于RET转染重排基因融合阳性肿瘤，2B类证据）；纳武利尤单抗+伊匹木单抗（适用于TMB-H肿瘤，标准疗法难治性疾病或没有可用标准治疗方案者，2B类证据）。