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Abstract：
Hepatocellular carcinoma (HCC) is the fourth most common cancer and the second leading cause of cancer-related death in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan developed and updated the guidelines for HCC management in 2020. In clinical practice, we follow these guidelines and the reimbursement policy of the government. In Taiwan, abdominal ultrasonography, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) tests are performed for HCC surveillance every 6 months or every 3 months for high-risk patients. Dynamic computed tomography, magnetic resonance imaging, and contrast-enhanced ultrasound have been recommended for HCC surveillance in extremely high-risk patients or those with poor ultrasonographic visualization results. HCC is usually diagnosed through dynamic imaging, and pathological diagnosis is recommended. Staging of HCC is based on a modified version of the Barcelona Clinic Liver Cancer (BCLC) system, and the HCC management guidelines in Taiwan actively promote curative treatments including surgery and locoregional therapy for BCLC stage B or C patients. Transarterial chemoembolization (TACE), drug-eluting bead TACE, transarterial radioembolization, and hepatic artery infusion chemotherapy may be administered for patients with BCLC stage B or C HCC. Sorafenib and lenvatinib are reimbursed as systemic therapies, and regorafenib and ramucirumab may be reimbursed in cases of sorafenib failure. First-line atezolizumab with bevacizumab is not yet reimbursed but may be administered in clinical practice. Systemic therapy and external beam radiation therapy may be used in specific patients. Early switching to systemic therapy in TACE-refractory patients is a recent paradigm shift in HCC management.
摘要：
肝细胞癌（HCC）是台湾第四大最常见的癌症，也是癌症相关死亡的第二大原因。台湾肝癌协会和台湾胃肠病学会在2020年制定并更新了HCC管理指南。在临床实践中,我们遵循这些准则和政府的报销政策。腹部超声检查,甲胎蛋白,和蛋白质诱导的维生素K缺乏或拮抗剂-II（PIVKA-II）测试进行肝癌监测每6个月，高危患者可缩短至3个月。动态计算机断层扫描,磁共振成像，对于高危或超声显像效果差的患者,可推荐超声造影用于HCC监测.HCC通常通过动态成像诊断，建议病理诊断。肝癌的分期是基于巴塞罗那临床肝癌（BCLC）系统的修改版本，台湾的肝癌管理指南积极推广治愈性治疗，包括BCLC-B-C患者的手术和局部治疗。Suetal.4经肝动脉化疗栓塞术(TACE),药物洗脱珠TACE，放射性栓塞,BCLC-B-CHCC患者可以进行肝动脉灌注化疗。索拉非尼和乐伐替尼作为全身疗法报销，在索拉非尼失败的情况下，瑞戈非尼和雷莫西单抗可以报销。一线阿替珠单抗与贝伐单抗尚未报销，但可以在临床实践中使用。化疗和外部束放射治疗可用于特定患者。TACE难治性患者早期转向全身治疗是HCC管理的最新范式转变。
