Abstract: Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decision-making, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.

Keywords: hepatocellular carcinoma, transarterial chemoembolization, survival prediction, treatment decision support, practical step-by-step guide

中文翻译：

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确定从TACE治疗中受益的患者的当前策略和未来方向的实用分步指南

摘要：肝细胞癌（HCC）的治疗取决于疾病的阶段。在西半球，巴塞罗那临床肝癌分类（BCLC）是首选的分期系统。大约有三分之一的患者最初出现中期疾病。对于这些患者，经动脉化学栓塞（TACE）是首选治疗方法。然而，中间阶段包括患者的异质性亚组，在肿瘤负荷和肝功能方面存在相当大的差异。此外，BCLC框架未捕获的个体因素的差异（例如肿瘤生长方式，血管过度程度和血管供应）使这些患者的进一步评估变得复杂。由于这些差异，并非所有患者都能从TACE中平等受益。已经设计了几种工具和评分系统来提供决策支持。所有这些均显示出令人鼓舞的初步结果，但外部评估未通过，因此尚未转诊至临床。然而，在疾病的所有阶段都需要在日常临床实践中客观化治疗决策的标准。因此，本综述提供了有关当前患者选择和决策策略的简明实用分步指南，重点是TACE，以严格评估现有的决策支持工具并提供了最新更新的摘要。场地。在疾病的所有阶段都需要在日常临床实践中客观化治疗决策的标准。因此，本综述提供了有关当前患者选择和决策策略的简明实用分步指南，重点是TACE，以严格评估现有的决策支持工具并提供了最新更新的摘要。场地。在疾病的所有阶段都需要在日常临床实践中客观化治疗决策的标准。因此，本综述提供了有关当前患者选择和决策策略的简明实用分步指南，重点是TACE，以严格评估现有的决策支持工具并提供了最新更新的摘要。场地。

关键词：肝细胞癌；经动脉化学栓塞；生存预测；治疗决策支持；实用的分步指南