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1、SEMINARSINLIVERDISEASE-VOL.19,NO.3,1999PrognosisofHepatocellularCarcinoma:TheBCLCStagingClassificationJOSEPM.LLOVET,M.D.,CONCEPCIOBRU,M.D.,andJORDlBRUIX,M.D.ABSTRACTTheclassificationsofhepatocellularcarcinoma(HCC)currentlyusedarebusedonprognosticfac-torsobta
2、inedfromstudiesperformedyearsagowhenmosttumorswerediagnosedatadvancedstagesandthesur-vivalratesweresubstantiallypoor.Recentinvestigationshavereviewedthesurvivalofearlytumorsproperlyse-lectedtoreceiveradicaltherapiesandthenaturaloutcomeofnonsurgicalHCCpatient
3、s.Thesedataenableanewstagingsystemtobeproposed,theBarcelonaClinicLiverCancer(BCLC)stagingclassification,thatcomprisesfourstagesthatselectthebestcandidatesforthebesttherapiescurrentlyavailable.Earlystage(A)includespatientswith~rsymptomaticearlytumorssuitablef
4、orradicaltherapies-resection,transplantationorpercutaneoustreatments.Intermediatestage(B)comprisespatientswithasymptomaticmultinodulurHCC.Advancedstage(C)includespa-tientswithsymptomatictumorsand/oraninvasivetumoralpattern(vascularinvasion/extrahepaticspread
5、).StageBandCpatientsmayreceivepalliativetreatments/newagentsinthesettingofphase11investigationsorrandomizedcontrolledtrials.End-stagediseuse(D)containpatientswithextremelygrimprognosis(OkudastageI11orPST3-4)thatshouldmerelyreceivesymptomatictreatment.KEYWORD
6、S:hepatocellularcarcinoma,prognosticfactors,stagingThereisnoagreementonwhichstagingsystempatients,butmostofthemincludelargeseriesofindi-shouldbeappliedincirrhoticpatientswithhepatocellu-vidualsdiagnosedatadvancedstagesmorethan10larcarcinoma(HCC).Thisisduetot
7、heincompleteyearsago,whenregularscreeningwasuncommonandknowledgeofthenaturalhistoryofthisneoplasmandtheimagingassessmentwaslessaccurate.1-14Duringthefactorspredictingitsprognosis.Severalretrospec-thelastyears,theimplementationofscreeningpro-tivestudieshavede
8、scribedtheclinicalcourseofHCCgramsinhigh-riskpopulationshasledtoanincreasedObjectivesUponcompletionofthisarticle,thereadershouldbeableto:1)appreciatetheneedforanewclassificationofHCCpatients;2)l
