[Present treatment situation of hepatocellular carcinoma with extrahepatic metastasis].

With the development of diagnostic and screening technologies, the incidence of hepatocellular carcinoma (HCC) with extrahepatic metastasis is increasing. It is a kind of refractory disease with extremely poor prognosis. Currently, there is no standard therapy. The existing guidelines only recommend targeted therapy, systemic chemotherapy or best supportive care for HCC patients with extrahepatic metastasis, but have not mentioned surgical therapy.Several studies have shown that the majority of HCC patients with extrahepatic metastasis died of progressive intrahepatic tumor leading to hepatic failure, but not extrahepatic metastases; and primary tumor resection may have a favorable impact on the prognosis of these patients with resectable primary tumors.Furthermore, the role of resection of metastatic tumors for HCC patients with extrahepatic metastasis remains unclear so far.Majority of experts think that resection of lung metastases has survival benefit when the hepatic lesion is resected or controlled, whereas resection of lymph nodes, bone metastases, adrenal gland lesions, or brain metastases does not prolong survival, which may be recommended when the goal is to relieve symptoms or improve quality of life.Therefore, surgical treatment is important for HCC patients with extrahepatic metastasis, and surgical therapy combined with personalized systemic treatment shows survival benefit for selected patients.随着诊断及筛查技术的不断进步，肝癌合并肝外转移的发现率逐年增加，其治疗较为困难且预后较差。目前尚无统一的肝癌合并肝外转移的治疗标准，各类指南仅建议行靶向治疗、系统化疗或最佳支持治疗，对于外科手术在肝癌合并肝外转移治疗中的价值并未具体描述。多项研究的结果表明，多数肝癌合并肝外转移患者死于肝内肿瘤进展所致的肝功能衰竭，而非肝外转移，对肝内原发肿瘤可切除但早期即发生肝外转移的患者，切除肝内原发灶可带来生存获益。对于转移灶切除在治疗肝癌合并肝外转移中的作用目前争议较大，多数学者认为对于肝癌肺转移的患者，在肝内原发病灶切除或控制良好的情况下进行有选择的外科手术治疗是有益的，对于淋巴结转移、骨转移、肾上腺转移、脑转移灶的手术切除并未显示出明显的生存获益，仅在需要缓解症状及改善生活质量时予以考虑。因此，肝癌即使出现肝外转移仍不可忽视外科手术的作用，对于部分严格筛选的患者外科手术加个体化的综合治疗仍可带来生存获益。.