Hepatocellular carcinoma appears frequently in patients with cirrhosis. Surveillance by biannual ultrasound is recommended for such patients because it allows diagnosis at an early stage, when effective therapies are feasible. The best candidates for resection are patients with a solitary tumour and preserved liver function. Liver transplantation benefits patients who are not good candidates for surgical resection, and the best candidates are those within Milan criteria (solitary tumour ≤5 cm or up to three nodules ≤3 cm). Image-guided ablation is the most frequently used therapeutic strategy, but its efficacy is limited by the size of the tumour and its localisation. Chemoembolisation has survival benefit in asymptomatic patients with multifocal disease without vascular invasion or extrahepatic spread. Finally, sorafenib, lenvatinib, which is non-inferior to sorafenib, and regorafenib increase survival and are the standard treatments in advanced hepatocellular carcinoma. This Seminar summarises the scientific evidence that supports the current recommendations for clinical practice, and discusses the areas in which more research is needed.

中文翻译：

---

肝细胞癌。

肝硬化患者经常出现肝细胞癌。建议对此类患者进行半年一次的超声监测，因为这样可以在可行的有效治疗方法的早期进行诊断。患有单发肿瘤并保留肝功能的患者最适合切除。肝移植有益于那些不适合手术切除的患者，而最佳候选者是那些在米兰标准范围内的患者（单发肿瘤≤5cm或最多三个结节≤3cm）。图像引导消融是最常用的治疗策略，但其疗效受肿瘤大小及其部位限制。化学栓塞在无血管病变或肝外扩散的无症状多灶性疾病患者中具有生存获益。最后，索拉非尼，lenvatinib，不低于索拉非尼和雷戈非尼可提高生存率，是晚期肝细胞癌的标准治疗方法。该研讨会总结了支持当前临床实践建议的科学证据，并讨论了需要更多研究的领域。