2014-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657254摘要：肝細胞癌（簡稱肝癌）是全世界常見的癌之一，自從 1984 至今，肝癌就高居台灣十大癌症死因的首位，每年大約有 8000 國人死於肝癌。肝癌的整體存活雖然不夠理想，但是以超音波及甲種胎兒蛋白定期追蹤檢查，可以早期篩檢出肝癌，5 年的存活率可以達到 50%以上。 癌症分期是很重要的東西，目前美國肝病醫學會(AASLD)以及歐洲肝病醫學會(EASL)都是推薦 BCLC 的分期方式。BCLC 總共分為 5 期，BCLC stage 0(極早期)、BCLC stage A(早期)、BCLC stage B(中期)、BCLC stage C(晚期)、BCLC stage D(末期)。BCLC的分期方式是否為最好的分期方式，目前仍有很多的爭議。檢視 BCLC 分期，可以發現stage B 跟 stage C 是由很多異質性的族群組成的。國外的研究者於去年對於 BCLC stage B 的分期提出了修正，認為 stage B 是一個異質性的族群，應該分為 stage B1-stage B4。這個對 BCLC stage B 的修正案，目前仍需要更多的數據來加以驗證。截至目前為止，還沒有研究者提出對於 BCLC stage C 分期的修正案，因此，我們檢視 BCLC stage C 的組成成分後，我們提出以下的假設，BCLC stage C 應該可以再細分為 C1~C3。BCLC stage C1: Portal vein branch invasion；BCLC stage C2: Main portal vein invasion；BCLC stage C3: Extrahepatic spread。 本研究的主要目的，是要建立台大醫院最近 6 年來(2006 至 2011)的肝癌資料庫，以達到以下兩個目的。（1）驗證由國外學者提出的 BCLC stage B 的病人，再細分為 B1-B4，這樣的情況是不是合適台灣肝癌病人。(2)檢證及支持我們上述所提出的 BCLC stage C分期的修正案。我們的結果將可以支持現行 BCLC 分期系統，是否在 stage B 及 stage C需要再分亞期，以便符合我們在臨床照顧病人以及日後臨床試驗的需要。<br> Abstract: Hepatocellular carcinoma (HCC) is one the most common malignancies in the world. About 8000 people died of this cancer every year in Taiwan. Early detection of HCC is possible by regular surveillance using alpha-fetoprotein and abdominal ultrasound. The 5-year survival can reach to more than 50% in early cases. Cancer staging system is important for the optimal management of cancer patients. Several staging systems have been proposed for HCC patients, such TNM, CLIP, BCLC, Tokyo, JIS etc. Both AASLD and EASL endorse BCLC as the recommended staging system for HCC. According to BCLC, HCC is classified to five stages: stage 0, A, B, C, and D. However, there are still tremendous debates regarding whether BCLC staging is the best for HCC. Because the components of BCLC staging include tumor size, tumor number, vascular invasion, performance status and Child status, the same BCLC stage is actually not a homogeneous group. Some investigators propose that BCLC stage B should be sub-classified as B1~B4. However, we need more data to validate such revision of BCLC stage B. Similarly, BCLC stage C is also a heterogeneous group. So far, there is no proposal to revise BCLC stage C. Therefore, we propose that BCLC stage C could be sub-classified into three stage. BCLC stage C1: Portal vein branch invasion；BCLC stage C2: Main portal vein invasion；BCLC stage C3: Extrahepatic spread。 We have set up a HCC database in the past. The existing HCC database composed of patients diagnosed from 1981 till 2000. The major drawbacks of this database are that few patients received radiofrequency ablation. None of them received target therapy because target therapy was not available at that time. Thus, this database could not be used in this study. Therefore, we will build a new HCC database by chart-review on HCC patients in this study. We will include HCC patients diagnosed from 2006 to 2011. The aims of this study are (1) To validate the sub-classification of BCLC stage B into B1~B4, (2) To test our hypothesis that BCLC stage C could be sub-classified to C1~C3. Our results can help us refine the BCLC staging system. We believe that a refined BCLC staging system might be more suitable for clinical practice and even for patient enrollment in clinical trials.肝細胞癌分期BCLChepatocellular carcinomastagingBCLC