The aim of any oncological treatment is not just to eliminate the tumour, but to maximise patient survival and quality of life. Since the liver has a vital function, any radical treatment that severely compromises liver function will result in a shortening of life expectancy, rather than a prolongation. Furthermore, even non-severe liver damage may prevent the delivery of further effective therapies. This is particularly important in the case of hepatocellular carcinoma (HCC), as it is associated with underlying cirrhosis in most patients – cirrhosis itself is not only a potentially lethal disease and independent prognostic factor in HCC, but it also makes liver function fragile. Accordingly, some information about liver dysfunction is included in most staging systems for HCC and can be used to guide the selection of treatments that the functional liver reserve can tolerate. Unfortunately, the prediction of functional damage to the liver in the case of antitumor treatments is very challenging and still suboptimal in any given patient. Moreover, while the assessment of functional reserve can now be used to avoid postoperative liver failure in the surgical setting, its use has been less well clarified for non-surgical therapies, which is of particular relevance today, as several lines of effective non-surgical treatments, including systemic therapies, have become available. The present article will a) critically review the implications of the assessment of liver functional reserve in patients with HCC, b) illustrate the available tools to assess liver functional reserve and c) discuss the role of functional assessment for each type of non-surgical therapy for HCC.

任何肿瘤治疗的目的不仅仅是消除肿瘤，而是最大限度地提高患者的生存率和生活质量。由于肝脏具有重要的功能，任何严重损害肝功能的根治性治疗都将导致预期寿命缩短，而不是延长。此外，即使是非严重的肝损伤也可能阻止进一步有效的治疗。这在肝细胞癌 (HCC) 的情况下尤其重要，因为它与大多数患者的潜在肝硬化有关——肝硬化本身不仅是 HCC 的潜在致命疾病和独立的预后因素，而且还会使肝功能变得脆弱。因此，关于肝功能障碍的一些信息包含在大多数 HCC 分期系统中，可用于指导功能性肝储备可以耐受的治疗选择。不幸的是，在抗肿瘤治疗的情况下预测肝脏的功能损伤是非常具有挑战性的，并且在任何给定的患者中仍然不是最理想的。此外，虽然功能储备的评估现在可用于避免手术环境中的术后肝功能衰竭，但其在非手术治疗中的应用尚不清楚，这在今天特别重要，因为有几条有效的非手术疗法治疗，包括全身治疗，已经可用。本文将 a) 批判性地回顾评估 HCC 患者肝功能储备的意义，