Patients with advanced hepatocellular carcinoma (HCC) with macrovascular invasion, that is, tumor thrombosis in the portal vein or hepatic vein, are generally considered not eligible for liver resection in Western countries, and only systemic therapy is recommended. However, there is a subgroup of patients who can survive long after surgical treatment despite having a very advanced stage of the disease. Some Asian surgical centers and a few Western surgical centers have been using surgery to treat BCLC stage C HCC as long as it is operable, and those centers have reported acceptable outcomes. In this issue of Liver Cancer, Govalan et al. report on the superiority of surgical resection over other treatments for patients with vascular invasion based on data from the National Cancer Database. This is a first report analyzing a large set of contemporary US cohort data, and its findings may catch the attention of many hepatologists in Western countries who are hesitant about sending eligible patients to surgeons. In this era of advanced systemic therapy using molecular targeted agents and immuno-check point inhibitors, a combination of promising systemic therapy and surgery may be a future path to improve survival for patients with this very advanced disease.
Liver Cancer

中文翻译：

---

肝切除术治疗血管浸润肝细胞癌的作用：来自西方国家的新证据

晚期肝细胞癌（HCC）伴有大血管侵犯，即门静脉或肝静脉内有肿瘤血栓形成，西方国家一般认为不适合肝切除术，仅推荐全身治疗。然而，有一部分患者尽管处于非常晚期的疾病阶段，但在手术治疗后仍能存活很长时间。一些亚洲外科中心和少数西方外科中心一直在使用手术治疗 BCLC C 期 HCC，只要它可以手术，并且这些中心报告的结果可以接受。在本期肝癌，戈瓦兰等人。根据国家癌症数据库的数据，报告了手术切除优于其他血管侵犯患者的治疗方法。这是第一份分析大量当代美国队列数据的报告，其研究结果可能会引起西方国家许多肝病学家的注意，他们对将符合条件的患者送到外科医生处犹豫不决。在这个使用分子靶向药物和免疫检查点抑制剂进行先进全身治疗的时代，有希望的全身治疗和手术相结合可能是提高这种非常晚期疾病患者生存率的未来途径。
肝癌