Article(id=1317885700435985148, tenantId=1146029695717560320, journalId=1316781422847033486, issueId=1317885672153797495, articleNumber=null, orderNo=null, doi=10.12449/JCH260814, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1780070400000, receivedDateStr=2026-05-30, revisedDate=null, revisedDateStr=null, acceptedDate=1780848000000, acceptedDateStr=2026-06-08, onlineDate=1792138036115, onlineDateStr=2026-10-16, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792138036115, onlineIssueDateStr=2026-10-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792138036115, creator=13701087609, updateTime=1792138036115, updator=13701087609, issue=Issue{id=1317885672153797495, tenantId=1146029695717560320, journalId=1316781422847033486, year='2026', volume='42', issue='8', pageStart='1745', pageEnd='2000', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1792138029373, creator='13701087609', updateTime=1792138608261, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1317888100290900262, tenantId=1146029695717560320, journalId=1316781422847033486, issueId=1317885672153797495, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1317888100290900263, tenantId=1146029695717560320, journalId=1316781422847033486, issueId=1317885672153797495, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1826, endPage=1830, ext={EN=ArticleExt(id=1317885700633117437, articleId=1317885700435985148, tenantId=1146029695717560320, journalId=1316781422847033486, language=EN, title=An excerpt of BCLC strategy for prognosis prediction and treatment recommendations:The 2026 update, columnId=1317885687655936448, journalTitle=Journal of Clinical Hepatology, columnName=Guideline, runingTitle=null, highlight=null, articleAbstract=

The Barcelona Clinic Liver Cancer (BCLC) system is a major international framework for hepatocellular carcinoma prognostic assessment and treatment decision-making. While preserving the overall architecture of the 2022 edition,the 2026 update integrates the latest research evidence in locoregional therapy,systemic therapy,and liver transplantation,emphasizes a direct correspondence between staging and evidence-based first-line treatment options,and highlights the refined assessment of liver function,individualized decision-making,and pathway optimization in complex scenarios. This article gives an excerpt of the core concepts,key definitions,and key points regarding first-line treatment options for different stages in the 2026 update,with brief comments on the clinical practice in China.

, authors=Jihua Xue1, Qingfen Ye2, Yinying Lu3, authorsList=Jihua Xue, Qingfen Ye, Yinying Lu, authorCompany=null, correspAuthors=Yinying Lu, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1317885700960273150, articleId=1317885700435985148, tenantId=1146029695717560320, journalId=1316781422847033486, language=CN, title=《巴塞罗那肝癌临床分期预后评估与治疗推荐策略:2026更新版》摘译, columnId=1317885688037618114, journalTitle=临床肝胆病杂志, columnName=指南与规范, runingTitle=null, highlight=null, articleAbstract=

巴塞罗那肝癌临床分期(BCLC分期)系统是肝细胞癌预后评估与治疗决策的重要国际框架。BCLC 2026版在保留2022版总体架构的基础上,整合了局部治疗、系统治疗及肝移植领域的最新研究证据,强调各分期与循证医学支持的首次治疗选择直接对应,突出肝功能精细评估、个体化决策及复杂情境下的路径优化。本文对BCLC 2026版的核心观念、关键定义及各阶段首次治疗选择要点进行摘译,并结合我国临床实践作简要评述。

, authors=薛继华1, 叶庆芬2, 陆荫英3, authorsList=薛继华, 叶庆芬, 陆荫英, authorCompany=null, correspAuthors=陆荫英, authorNote=

作者贡献声明

薛继华、叶庆芬负责翻译;陆荫英负责审校。薛继华与叶庆芬对本文贡献等同,同为第一作者。

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陆荫英, (ORCID:0000-0002-7737-2334)
Lu Yinying, (ORCID:0000-0002-7737-2334)
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《巴塞罗那肝癌临床分期预后评估与治疗推荐策略:2026更新版》摘译
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薛继华 1 , 叶庆芬 2 , 陆荫英 3
临床肝胆病杂志 | 指南与规范 2026,42(8): 1826-1830
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临床肝胆病杂志 |指南与规范 2026 , 42 (8) : 1826 -1830
《巴塞罗那肝癌临床分期预后评估与治疗推荐策略:2026更新版》摘译
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薛继华1, 叶庆芬2, 陆荫英3
作者信息
  • 1安徽医科大学第一附属医院感染病科,合肥 230022
  • 2成都市公共卫生临床医疗中心,成都 610000
  • 3中国人民解放军总医院第五医学中心肝病医学部,北京 100039
通讯作者:
陆荫英, (ORCID:0000-0002-7737-2334)
Lu Yinying, (ORCID:0000-0002-7737-2334)
作者简介:

作者贡献声明

薛继华、叶庆芬负责翻译;陆荫英负责审校。薛继华与叶庆芬对本文贡献等同,同为第一作者。

An excerpt of BCLC strategy for prognosis prediction and treatment recommendations:The 2026 update
Jihua Xue1, Qingfen Ye2, Yinying Lu3
Affiliations
  • 1Department of Infectious Diseases,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China
  • 2Public Health Clinical Center of Chengdu,Chengdu 610000,China
  • 3Senior Department of Hepatology,The Fifth Medical Center of PLA General Hospital,Beijing 100039,China
出版时间: 2026-08-25 doi: 10.12449/JCH260814
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巴塞罗那肝癌临床分期(BCLC分期)系统是肝细胞癌预后评估与治疗决策的重要国际框架。BCLC 2026版在保留2022版总体架构的基础上,整合了局部治疗、系统治疗及肝移植领域的最新研究证据,强调各分期与循证医学支持的首次治疗选择直接对应,突出肝功能精细评估、个体化决策及复杂情境下的路径优化。本文对BCLC 2026版的核心观念、关键定义及各阶段首次治疗选择要点进行摘译,并结合我国临床实践作简要评述。

癌,肝细胞  /  巴塞罗那肝癌临床分期  /  预后  /  病人遴选  /  临床决策

The Barcelona Clinic Liver Cancer (BCLC) system is a major international framework for hepatocellular carcinoma prognostic assessment and treatment decision-making. While preserving the overall architecture of the 2022 edition,the 2026 update integrates the latest research evidence in locoregional therapy,systemic therapy,and liver transplantation,emphasizes a direct correspondence between staging and evidence-based first-line treatment options,and highlights the refined assessment of liver function,individualized decision-making,and pathway optimization in complex scenarios. This article gives an excerpt of the core concepts,key definitions,and key points regarding first-line treatment options for different stages in the 2026 update,with brief comments on the clinical practice in China.

Carcinoma,Hepatocellular  /  Barcelona Clinic Liver Cancer Staging  /  Prognosis  /  Patient Selection  /  Clinical Decision-Making
薛继华, 叶庆芬, 陆荫英. 《巴塞罗那肝癌临床分期预后评估与治疗推荐策略:2026更新版》摘译. 临床肝胆病杂志, 2026 , 42 (8) : 1826 -1830 . DOI: 10.12449/JCH260814
Jihua Xue, Qingfen Ye, Yinying Lu. An excerpt of BCLC strategy for prognosis prediction and treatment recommendations:The 2026 update[J]. Journal of Clinical Hepatology, 2026 , 42 (8) : 1826 -1830 . DOI: 10.12449/JCH260814
肝细胞癌(hepatocellular carcinoma,HCC)的临床管理同时受肿瘤负荷、肝功能储备及宿主状态影响,仅依据肿瘤范围分配治疗难以覆盖真实世界复杂性。巴塞罗那肝癌临床分期(Barcelona clinic liver cancer staging,BCLC分期)体系已发展为兼具预后评估与治疗推荐功能的综合框架。BCLC 2026版在保留2022版整体架构的基础上,吸纳了局部治疗、系统治疗、肝移植及复杂决策领域的最新研究证据,继续坚持各分期直接对应循证支持的首次治疗选择,并依据总体生存获益的证据层级进行优先排序[1]。
BCLC 2026版并非一部按照推荐意见分级的评估、制定与评价体系(Grading of Recommendations Assessment,Development and Evaluation,GRADE)逐条标注推荐强度和证据质量的临床实践指南,而是以分期策略、预后评估和治疗路径推荐为核心的更新文件。本文中的“重要观念”与“不同BCLC分期首次治疗选择要点”均依据BCLC 2026版文中核心观点、各分期正文内容及治疗流程整理而成;“BCLC 2026版对我国临床实践的启示”则为结合我国临床实际作出的归纳总结。
BCLC 2026版仍坚持,HCC预后主要由肿瘤负荷、肝功能和肿瘤相关症状共同决定,延续采用“先总体分期、再分期内精细化决策”的两步法。本次更新保留了BCLC 0、A、B、C、D 5个分期的原有结构,进一步明确了BCLC B期“多灶”的定义,即病灶数量>3个,或病灶数量≤3个但至少有1个病灶直径>3 cm。
本次更新正式引入CUSE框架。CUSE分别代表复杂性(complexity)、不确定性(uncertainty)、主观性(subjectivity)和情绪因素(emotion);其作用并非替代循证医学,而是在证据与个体患者实际情况存在差异时,为多学科诊疗(multi-disciplinary team,MDT)提供结构化的决策路径。BCLC 2026版强调,当证据不足或不同方案的证据无法直接比较时,应当形成可复核、以患者治疗目标为导向的“optimal”(最优适配)方案,而非机械追求所谓“best”(绝对最佳)方案。
重要观念1:BCLC 2026版保留2022版总体分期架构,并进一步明确BCLC B期“多灶”定义。
重要观念2:HCC预后应围绕肿瘤负荷、肝功能和肿瘤相关症状综合判断;治疗选择应以分期为基础,并随证据进展和患者状态动态调整。
重要观念3:各BCLC分期的首次治疗选择依据总体生存获益相关证据层级优先排列;尚缺乏有成熟证据的治疗策略,仅作为待验证或替代序列予以介绍。
重要观念4:CUSE是具备灵活性的人本化决策支持框架,而非刚性协议;其核心是在MDT基础上,明确识别诊疗过程中的复杂性、不确定性、主观性和情绪因素,并将其纳入共同决策过程,进而形成可记录、可复盘且可迭代优化的个体化诊疗方案。
肿瘤负荷评估仍应以增强多期计算机体层成像(computed tomography,CT)或磁共振成像(magnetic resonance imaging,MRI)为基础,并由有经验的影像科医师参与判读,以减少过度分期或分期不足。必要时补充胸部CT;CT/MRI结论不确定时,增强超声可作为辅助工具,正电子发射体层成像不推荐常规用于HCC分期。
肝功能评估不应仅依赖蔡尔德-皮尤分级(Child-Pugh分级)。即使Child-Pugh A级患者,也可能存在腹水、既往曲张静脉出血或肝性脑病等失代偿表现,因此白蛋白-胆红素(albumin-bilirubin,ALBI)评分、失代偿事件及终末期肝病模型(model for end-stage liver disease,MELD)相关评估均应纳入综合判断。代偿或失代偿期肝硬化是进入治疗流程前的重要分界点;部分患者经病因治疗及并发症控制后可实现再代偿,并重新评估特定治疗路径。然而,HCC患者“再代偿”的具体标准尚待建立。
美国东部肿瘤协作组体力状况评分(Eastern Cooperative Oncology Group performance status score,ECOG体力状况评分)仍是跨分期预后评估因素,但针对高龄、合并失代偿期肝硬化或存在明显虚弱表现的患者,应联合虚弱评估结果与临床综合判断进行分析,避免将肝病相关疲乏、肌少症或并发症负担错误判定为肿瘤相关症状。甲胎蛋白水平升高提示患者预后较差,并可能影响肝移植资格,但不自动排除其他治疗选择。
重要观念5:BCLC 2026版不再将Child-Pugh分级作为肝功能评估的唯一依据,代偿/失代偿状态、ALBI评分、MELD相关指标及失代偿事件均应纳入综合判断。
重要观念6:ECOG体力状况评分仍具有重要的预后评估价值,但对于高龄、合并失代偿期肝硬化或存在明显虚弱表现的患者,应结合虚弱评估结果与临床综合判断进行分析。
CUSE框架适用于“已有临床证据与个体患者实际情况之间存在差异”的诊疗场景,旨在帮助MDT明确识别诊疗过程中的复杂性、不确定性、患者偏好及情绪因素,并将其纳入结构化共同决策过程;其核心是在循证医学的基础上,正视真实临床场景中不可回避的不确定性。
CUSE要求诊疗团队明确治疗目标,例如治愈、延长生存、控制肿瘤、改善症状或维持生活质量;随后对患者肝脏储备、体能状态、虚弱程度、合并症情况、治疗可及性、支付能力及照护能力进行评估;再将基于人群的循证证据转化为适用于该个体的可行诊疗路径,并通过MDT与患者共同完成决策。该过程应当记录决策理由、患者知情同意结果及动态复评节点。在证据层级方面,BCLC 2026版仍继续将优先权重赋予前瞻性研究,尤其是随机对照试验;回顾性研究即使采用倾向评分匹配或逆概率处理加权等统计学方法调整,也难以完全消除结构性选择偏倚。
重要观念7:CUSE框架适用于现有证据不足、不同诊疗方案证据无法直接比较,或患者临床与社会情境复杂的场景,可通过“目标设定-情境评估-证据转化-MDT讨论-共同决策-动态复评”的流程形成个体化诊疗路径。
BCLC 2026版进一步强化了TSM概念,即当默认治疗路径因合并症、年龄或虚弱状态、技术不可行性、可及性受限、患者意愿改变、显著缓解或当前治疗策略失败等不再适用时,可在CUSE框架下转入其他治疗路径。
其中,UTP是触发治疗阶段迁移的重要因素之一。该概念最初针对经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)提出,BCLC 2026版将其适用范围拓展至所有BCLC分期。UTP提示当前治疗策略已失效,即使尚未出现明确的影像学进展,也应转入下一BCLC分期所推荐的治疗策略。
免疫治疗时代亦引发了“治疗应答后如何重新界定BCLC分期”这一议题。BCLC 2026版认为,显著肿瘤退缩并不意味着患者简单“回归至早期分期”,而是更接近于一种新的临床状态,即“可治疗性肿瘤退缩”。局部治疗后降期进入移植路径已有较强证据支持;系统治疗后的降期与转化治疗虽前景积极,但总体上仍属证据尚不充分的替代序列或待验证策略。
重要观念8:UTP是触发治疗阶段迁移的重要因素之一,提示当前治疗策略已失效;即使尚未出现明确的影像学进展,也应转入下一BCLC分期所推荐的治疗策略。TSM的适用范围更广,还包括合并症、年龄或虚弱状态、治疗可行性或可及性受限、治疗后显著应答,以及患者意愿或价值取向变化等情况。
重要观念9:显著肿瘤退缩后的患者并非简单回归既往BCLC分期,而可能进入“可治疗性肿瘤退缩”的临床状态,需结合CUSE框架重新评估移植、局部巩固治疗或维持系统治疗方案。
BCLC 0期定义为单发肿瘤、直径≤2 cm,无大血管侵犯或肝外转移,肝功能储备良好且无肿瘤相关症状。该分期的治疗选择需结合肝移植可及性与门静脉高压状况确定:无临床显著门静脉高压者优先选择肝切除;不适合切除的患者,以经皮热消融作为主要根治策略。当肝移植不适用,且热消融不可行或并非最优方案时,经动脉放射栓塞术(transarterial radioembolization,TARE)和外照射放疗(external-beam radiotherapy,EBRT)可作为有效的替代局部方案,但不推荐作为取代切除或消融的通用标准方案。
不同BCLC分期首次治疗选择要点1:BCLC 0期的治疗选择应结合肝移植可及性与门静脉高压状况确定,TARE或EBRT可在特定临床情境下作为有效的替代治疗方案。
BCLC A期定义为单发肝内病灶直径>2 cm,或存在≤3个结节且每个结节直径≤3 cm,无大血管侵犯与肝外转移,肝功能储备良好且ECOG体力状况评分为0。单发病灶的治疗选择,应依据临床显著门静脉高压、病灶部位、肝功能储备及技术条件,在肝切除与消融之间确定优先级;符合米兰标准、无明显移植禁忌的多灶病变,优先评估肝移植治疗路径。
不同BCLC分期首次治疗选择要点2:BCLC A期单发病灶的治疗应依据临床显著门静脉高压、病灶部位及技术条件,在肝切除与消融之间确定优先级;符合米兰标准的多灶病变,优先评估肝移植治疗路径。
BCLC B期的“多灶”定义为病灶数目>3个,或病灶数目≤3个但至少1个病灶直径>3 cm。治疗大致分为三类:符合所在中心扩展肝移植标准的患者,可行肝移植治疗;肿瘤边界清楚、门静脉血流保留且可选择性进入供血动脉的患者,此类仍以TACE作为标准一线局部治疗;病灶呈弥漫性、浸润性生长或肝内广泛受累,难以实施有效选择性TACE的患者,更倾向于直接进入系统治疗路径。甲胎蛋白>1 000 ng/mL通常提示移植后复发风险过高,仅部分经降期治疗获得成功的患者,可重新评估肝移植指征。
尽管TARE、EBRT及多种联合治疗策略已取得积极研究结果,目前仍无稳健的头对头总生存期(overall survival,OS)证据支持其全面取代TACE。对于不适合TACE或技术层面难以实施有效TACE的患者,可在CUSE框架下考虑选择TARE或EBRT,以推迟系统治疗的启动,并将系统治疗保留至疾病进展或局部治疗失败后使用;但现有证据仍不支持将其作为普遍适用的一线替代方案。
不同BCLC分期首次治疗选择要点3:对于BCLC B期中适合接受选择性介入治疗的患者,TACE仍是标准一线局部治疗方案;对于难以实施有效选择性TACE的患者,应更早转入系统治疗路径。
BCLC C期包括存在大血管侵犯和/或肝外播散的患者;该分期不以肝内肿瘤负荷为限制条件,但患者通常应具备良好的肝功能储备,并维持ECOG体力状况评分0~2分。系统治疗仍是该分期的基础标准治疗方案,一线治疗应优先选用已在多区域随机临床试验中证实OS获益的免疫基础方案;若无法采用该方案,再考虑选择索拉非尼、仑伐替尼、度伐利尤单抗或替雷利珠单抗等方案。
局部治疗在BCLC C期中的应用地位仍需审慎评估。TARE、EBRT、肝动脉灌注化疗联合亚叶酸钙/氟尿嘧啶/奥沙利铂方案(hepatic arterial infusion chemotherapy with folinic acid/leucovorin,fluorouracil and oxaliplatin,HAIC-FOLFOX)、TACE联合系统治疗等策略虽展现出研究潜力,但目前尚无充分的直接证据支持其系统性取代标准一线系统治疗方案。尤其是HAIC-FOLFOX及部分TACE联合系统治疗的研究结果虽令人鼓舞,但相关研究主要来自亚洲及中国地区,尚不足以支持将其作为一般性一线治疗方案推荐。免疫治疗或应用仑伐替尼后的后续治疗路径,以及系统治疗后转化为根治性治疗的临床策略,仍需更多前瞻性研究证据加以明确。
不同BCLC分期首次治疗选择要点4:系统治疗仍是BCLC C期患者的标准治疗策略;局部治疗、HAIC、TARE、EBRT等可在特定人群中作为补充或序贯治疗策略,但应谨慎选择。
BCLC D期指存在严重肝功能不全和/或明显肿瘤相关症状,且不适合肝移植的患者。该分期治疗重点应从肿瘤控制转向症状缓解、支持治疗和姑息照护。临床实践中需区分严格定义的BCLC D期与广义的最佳支持治疗人群:前者中位OS约<3个月;BCLC 2026版流程图将BCLC D期预期中位OS修订为<12个月,该调整提示,接受最佳支持治疗的人群具有一定异质性。
不同BCLC分期首次治疗选择要点5:BCLC D期或失代偿期肝硬化且不适合移植/特异性抗肿瘤治疗者,应以最佳支持治疗、症状控制和生活质量维护为主;经病因治疗和并发症控制后实现再代偿者,可重新评估特定治疗路径。
BCLC 2026版强化“预后评估-治疗推荐”的一体化思路,通过CUSE框架、TSM、UTP及治疗后肿瘤退缩状态等概念,使HCC临床决策更契合动态管理需求。对我国临床实践而言,该分期体系可作为国际交流、临床研究分层及总体路径设计的重要参考,但不宜直接替代中国肝癌临床分期(China clinic liver cancer staging,CNLC分期)与本土专家共识。我国HCC患者多存在乙型肝炎病毒感染和肝硬化背景,初诊时肿瘤负荷普遍较大,合并门静脉癌栓(portal vein tumor thrombus,PVTT)、门静脉高压及肝功能边缘状态的病例较多,因此更需要在BCLC框架基础上开展进一步精细化分层与治疗排序。
《晚期原发性肝癌精细化诊疗管理专家共识(2023年版)》[2]对CNLC Ⅲ期或BCLC C期涵盖的异质性人群进行了更具操作性的细化分层,强调需结合肝功能状态、PVTT程氏分型及累及范围、肝外转移负荷、门静脉高压和病毒复制状态开展综合决策。该共识提出以Child-Pugh B级7分作为晚期HCC肝功能状态评估的重要界值,采用程氏分型作为PVTT分层依据,并将转移/复发病灶≤5个、累及器官≤2个作为肝癌寡转移的界定标准,可弥补单纯BCLC C期分层范围过宽、治疗推荐相对笼统的不足。
在治疗策略层面,应特别重视BCLC B期与BCLC C期之间的治疗衔接。BCLC B期患者需区分为TACE适宜人群、TACE难以获益或无法重复治疗人群,以及经降期治疗后可能获得肝移植或根治性治疗机会的人群;BCLC C期则应坚持以系统治疗为主,同时结合PVTT分型、肝内肿瘤负荷、肝外转移模式和肝功能储备,选择性联合TACE、HAIC、放疗、消融或外科治疗。对于Child-Pugh A级或B级7分以内、ECOG体力状况评分良好、PVTT Ⅰ~Ⅱ型且肿瘤相对局限的患者,经MDT评估后可考虑采用外科切除、TACE、放疗或系统治疗的联合策略;对于PVTT Ⅲ~Ⅳ型、肿瘤负荷较大但肝功能储备尚可的患者,合理整合HAIC、放疗与系统治疗具备临床应用价值;而存在广泛肝内受累、PVTT范围较大或肝功能不足的患者,应避免机械叠加局部治疗。
转化治疗及治疗后重新评估,同样是中国临床实践中需要审慎把握的重点。经系统治疗或局部联合治疗后肿瘤出现明显退缩的患者,可在MDT框架下重新评估转化切除、局部巩固治疗或肝移植的可能性,但现有证据尚不支持将转化治疗泛化为常规标准诊疗策略。后续治疗也不宜仅按“进展”笼统处理,应当区分肝内为主进展、肝外寡进展、系统性广泛进展、治疗不可耐受及肝功能恶化等不同模式,分别采取局部强化治疗、更换系统治疗方案、寡进展灶局部处理、保肝支持治疗或最佳支持治疗等对应方案。
此外,我国晚期HCC管理还应突出特殊人群和全程管理。乙型肝炎病毒/丙型肝炎病毒相关HCC患者在抗肿瘤治疗期间,应同步重视抗病毒治疗及病毒再激活监测;合并门静脉高压或食管胃底静脉曲张者,在选择含抗血管内皮生长因子方案前,应充分评估出血风险;Child-Pugh B级7分以内者,可在严密监测下谨慎进行抗肿瘤治疗,而Child-Pugh B级8/9分或已有明显失代偿事件者,应优先改善肝功能和控制并发症,待条件允许后再重新评估。总体而言,BCLC 2026版提供了国际通用框架,我国精细化诊疗共识则补充了真实世界晚期HCC患者的分层管理细节;二者结合,有助于提高治疗路径的适用性、安全性和个体化水平。
综上所述,BCLC 2026版在保持分期结构简洁性的基础上,引入CUSE框架以应对复杂情境下的个体化决策需求,并将新近的局部及系统治疗证据整合至分期-治疗框架中。其核心价值并非在于扩大“一刀切”式的推荐,而是将不确定性显性化,并将证据与患者目标、治疗可及性及安全性相结合。针对我国晚期肝癌患者中常见的乙型肝炎病毒相关背景、高肿瘤负荷、PVTT异质性、寡转移状态及Child-Pugh B不同亚层等特征,仍需结合CNLC分期及本土精细化诊疗共识进行补充优化。未来,应进一步验证CUSE框架对真实世界决策质量及临床结局的影响,并持续推进其实施过程的标准化。

参考文献 引证文献
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1
Reig M, Sanduzzi-Zamparelli M, Forner A, et al. BCLC strategy for prognosis prediction and treatment recommendations: The 2026 update[J]. J Hepatol, 2026, 84(3): 631-654. DOI: 10.1016/j.jhep.2025.10.020.
2
国家感染性疾病临床医学研究中心, 北京医学会肝病学分会, 中国老年学及老年医学学会转化医学分会. 晚期原发性肝癌精细化诊疗管理专家共识(2023年版)[J]. 中华肝脏病杂志, 2023, 31(9): 910-920. DOI: 10.3760/cma.j.cn501113-20230717-00006.
National Clinical Research Center for Infectious Diseases; Society of Hepatology, Beijing Medical Association; Translational Medicine Branch, China Association of Gerontology and Geriatrics. Expert consensus on precise diagnosis and management of primary hepatocellular carcinoma in advanced stage (2023 version)[J]. Chin J Hepatol, 2023, 31(9): 910-920. DOI: 10.3760/cma.j.cn501113-20230717-00006.
2026年第42卷第8期
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doi: 10.12449/JCH260814
  • 接收时间:2026-05-30
  • 首发时间:2026-10-16
  • 出版时间:2026-08-25
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  • 收稿日期:2026-05-30
  • 录用日期:2026-06-08
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    1安徽医科大学第一附属医院感染病科,合肥 230022
    2成都市公共卫生临床医疗中心,成都 610000
    3中国人民解放军总医院第五医学中心肝病医学部,北京 100039

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陆荫英, (ORCID:0000-0002-7737-2334)
Lu Yinying, (ORCID:0000-0002-7737-2334)
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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