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Hepatozelluläres Karzinom

Hepatocellular carcinoma

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Zusammenfassung

Das therapeutische Spektrum des hepatozellulären Karzinoms (HCC) bei Leberzirrhose hat sich im letzten Jahrzehnt erweitert und umfasst chirurgische, interventionelle und systemische Ansätze. Das Tumorstadium und die Leberfunktion sind wichtig für die therapeutische Strategie. Eine Heilung kann durch Leberresektion oder Lebertransplantation erreicht werden. Der Zugang zur Transplantation ist durch den Organmangel und die Wartezeit begrenzt. Lokoregionale Therapien können als Überbrückung bis zur Transplantation oder zur Verkleinerung im Rahmen einer neoadjuvanten Behandlung sowie als Palliativtherapie eingesetzt werden. Fortgeschrittene Stadien können von einer systemischen oder Immuntherapie profitieren. Die moderne multimodale Therapieplanung, das Timing und die Reevaluation gehören zu den Aufgaben des auf die Leber spezialisierten Tumorboards, einschließlich der Option einer Lebertransplantation. Die Therapien können allein oder in Kombination und je nach Erfahrung des Zentrums eingesetzt werden. Bei der Erstvorstellung sollte immer eine kurative Strategie verfolgt werden.

Abstract

The therapeutic spectrum of hepatocellular carcinoma (HCC) in cirrhosis has expanded over the last decade and consists of surgical, interventional and systemic approaches. The tumor stage and liver function are important for the therapeutic strategy. Curation can be achieved by liver resection or transplantation. Access to transplantation is limited by organ shortage and waiting time. Locoregional therapies can be used as a bridge to transplant or for down-sizing in a neoadjuvant setting as well as palliative therapy. Advanced stages might benefit from systemic or immunotherapy. Modern multimodal therapy planning, timing and reevaluation are part of the tasks of tumor boards specialised in the liver, including the option of liver transplantation. Therapies can be used alone or in combination and according to the experience of the center. A curative strategy should always be pursued at initial presentation.

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Literatur

  1. Asrani SK et al (2022) Quality measures in HCC care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases. Hepatology 75(5):1289–1299

    Article  Google Scholar 

  2. Bernsmeier A, Braun F (2019) Lebertransplantation bei primären Lebertumoren und Lebermetastasen. Gastroenterologe 14:269–281

    Article  Google Scholar 

  3. Bundesärztekammer (2021) Richtlinie gem. § 16 Abs. 1 S. 1 Nrn. 2 und 5 TPG für die Wartelistenführung und Organvermittlung zur Lebertransplantation. http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/RL/RiliOrgaWlOvLeberTx20211102.pdf. Zugegriffen:: 31.05.2022

  4. Cunha GM, Hosseini M, Furlan A, Fowler KJ (2022) Hepatocellular Carcinoma Staging: Differences Between Radiologic and Pathologic Systems and Relevance to Patient Selection and Outcomes in Liver Transplantation. AJR Am J Roentgenol 218(1):77–86. https://doi.org/10.2214/AJR.21.26436. Epub 2021 Aug 18. PMID: 34406054

  5. el-Khoueiry AB et al (2017) Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet 389:2492–2502

    Article  CAS  Google Scholar 

  6. European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69(1):182–123

    Article  Google Scholar 

  7. Ferrer-Fàbrega J et al (2016) Prospective validation of ab initio liver transplantation in hepatocellular carcinoma upon detection of risk factors for recurrence after resection. Hepatology 63:839–849

    Article  Google Scholar 

  8. Finn RS et al (2020) Phase Ib study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma. J Clin Oncol 38:2960–2970

    Article  Google Scholar 

  9. Gerena M et al (2021) LI-RADS treatment response assessment of combination locoregional therapy for HCC. Abdom Radiol 46:3634–3647

    Article  Google Scholar 

  10. Gundlach JP et al (2021) Indication of liver transplantation for hepatocellular carcinoma should be reconsidered in case of microvascular invasion and multilocular tumor occurrence. J Clin Med 10(6):1155

    Article  CAS  Google Scholar 

  11. Heimbach JK et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67(1):358–378

    Article  Google Scholar 

  12. Huppert P (2022) Transarterielle Chemoembolisation des hepatozellulären Karzinoms. Radiologe 62(3):225–233

    Article  Google Scholar 

  13. Kloeckner R, Galle PR, Bruix J (2020) Local and regional therapies for hepatocellular carcinoma. Hepatology 73(S1):137–149

    Article  Google Scholar 

  14. Lurje I et al (2019) Treatment strategies for hepatocellular carcinoma – a multidisciplinary approach. Int J Mol Sci 20(6):1465

    Article  CAS  Google Scholar 

  15. Matsumoto MM et al (2021) Comparing real world, personalized, multidisciplinary tumor board recommendations with BCLC algorithm: 321-patient analysis. Cardiovasc Intervent Radiol 44(7):1070–1080

    Article  Google Scholar 

  16. Mazzaferro V (2007) Results of liver transplantation: with or without Milan criteria? Liver Transpl 13(11 Suppl 2):S44–S47

    Article  Google Scholar 

  17. McGlynn KA, Petrick JL, El‐Serag HB (2020) Epidemiology of Hepatocellular carcinoma. Hepatology 73(S1):4–13

    Article  Google Scholar 

  18. Mehdorn AS et al (2021) Usability of Indocyanine green in robot-assisted hepatic surgery. J Clin Med 10(3):456

    Article  CAS  Google Scholar 

  19. Mehta N et al (2021) Downstaging outcomes for hepatocellular carcinoma: results from the multicenter evaluation of reduction in tumor size before liver transplantation (MERITS-LT) consortium. Gastroenterology 161(5):1502–1512

    Article  CAS  Google Scholar 

  20. Mittal S, El-Serag HA (2013) Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol 47(Suppl 0):S2–S6

    Article  Google Scholar 

  21. Moura Cunha G et al (2021) Up-to-date role of CT/MRI LI-RADS in hepatocellular carcinoma. J Hepatocell Carcinoma 8:513–527

    Article  Google Scholar 

  22. Notarpaolo A et al (2017) Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC. J Hepatol 66(3):552–559

    Article  Google Scholar 

  23. Otto G et al (2013) How to decide about liver transplantation in patients with hepatocellular carcinoma: size and number of lesions or response to TACE? J Hepatol 59(2):279–284

    Article  Google Scholar 

  24. Pinyol R et al (2021) Molecular characterisation of hepatocellular carcinoma in patients with non-alcoholic steatohepatitis. J Hepatol 75(4):865–878

    Article  CAS  Google Scholar 

  25. Reig M et al (2021) BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 76(3):681–693

    Article  Google Scholar 

  26. Sapisochin G et al (2016) The extended toronto criteria for liver transplantation in patients with hepatocellular carcinoma: a prospective validation study. Hepatology 64(6):2077–2088

    Article  Google Scholar 

  27. Tang A, Fowler KJ, Chernyak V, Chapman WC, Sirlin CB (2018). LI-RADS and transplantation for hepatocellular carcinoma. Abdom Radiol (NY) 43(1):193–202. https://doi.org/10.1007/s00261-017-1210-8. PMID: 28612162

  28. Vibert E et al (2020) Advances in resection and transplantation for hepatocellular carcinoma. J Hepatol 72(2):262–276

    Article  CAS  Google Scholar 

  29. Voesch S et al (2022) S3-Leitlinie: Diagnostik und Therapie des hepatozellulären Karzinoms – Langversion 2.0 – Juni 2021, AWMF-Registernummer: 032-0530L. Z Gastroenterol 60(1):e131–e185

    Article  CAS  Google Scholar 

  30. Vogel A et al (2022) The use of immuno-oncologic therapy in hepatocellular carcinoma in the context of liver transplantation. An interdisciplinary benefit/risk assessment. Z Gastroenterol 60(2):184–191

    Article  CAS  Google Scholar 

  31. Wong TCL et al (2021) Prospective study of stereotactic body radiation therapy for hepatocellular carcinoma on waitlist for liver transplant. Hepatology 74(5):2580–2594. https://doi.org/10.1002/hep.31992

    Article  CAS  PubMed  Google Scholar 

  32. Yau T et al (2020) Efficacy and safety of nivolumab plus ipilimumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib: the checkmate 040 randomized clinical trial. JAMA Oncol 6(11):e204564

    Article  Google Scholar 

  33. Zhu AX et al (2018) Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol 19:940–952

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik für Allgemeine Chirurgie, Viszeral‑, Thorax- Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Deutschland

    Felix Braun FEBS, MBA, Thomas Becker & Michael Linecker

  2. Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Deutschland

    Jost Philipp Schäfer

  3. Klinik für Innere Medizin 1, UKSH, Campus Lübeck, Lübeck, Deutschland

    Henrike Dobbermann

  4. Sektion für Klinische Transplantationsmedizin, Klinik für Allgemeine Chirurgie, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Str. 3, Haus C, 24105, Kiel, Deutschland

    Felix Braun FEBS, MBA

Authors
  1. Felix Braun FEBS, MBA
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  2. Jost Philipp Schäfer
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  3. Henrike Dobbermann
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  4. Thomas Becker
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  5. Michael Linecker
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Corresponding author

Correspondence to Felix Braun FEBS, MBA.

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Interessenkonflikt

F. Braun, J.P. Schäfer, H. Dobbermann, T. Becker und M. Linecker geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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U. Settmacher, Jena

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Braun, F., Schäfer, J.P., Dobbermann, H. et al. Hepatozelluläres Karzinom. Chirurgie 93, 635–643 (2022). https://doi.org/10.1007/s00104-022-01661-4

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  • DOI: https://doi.org/10.1007/s00104-022-01661-4

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