《国际肝病》：您的团队在香港创建了肝细胞癌分期系统，请您简单介绍下这一系统?

　　邱宗祥博士：我们发现在亚洲特别是中国需要一个更好的肝癌分期方法。我们将患者分为从1期到5期，根据统计分析，每期患者接受不同的治疗建议。香港肝细胞癌（HKLC）分期系统研究的主要发现是建议对具有大块肿瘤、多发性肿瘤及血管侵犯的肿瘤的患者进行更积极的切除治疗策略。在统计分析中，发现这类患者经过更积极的外科治疗仍获得生存获益。部分这类患者不能进行外科治疗，根据香港肝细胞癌分期系统，如果患者处于3期，则可通过TACE或射频消融治疗获益。

　　Dr. Thomas Yau: Basically we found that we needed a better staging classification for liver cancer especially in Asia and particularly for China. We classify patients into stages from Stage 1 to Stage 5. Each stage receives different treatment recommendations according to our statistical analysis. The key finding of our Hong Kong Liver Cancer (HKLC) Staging System research is that we recommend more aggressive treatment for these patients including more aggressive resection strategies particularly where patients present with a large tumor, a multifocal tumor and a major branch of vascular invasion. During our statistical analysis, we found that these types of patients can still gain survival benefit with more aggressive surgical treatment. Some of these patients may not be surgical candidates, so according to the Hong Kong Liver Cancer Staging classification, if they are Stage 3, they may benefit substantially from TACE or radiofrequency ablation.

　　《国际肝病》：香港肝细胞癌分期系统可以给患者带来哪些获益？

　　邱宗祥博士：我们将HCC患者分成5期并给予相应的治疗推荐。1期和2期患者，可接受外科根治性切除治疗，或者对一些早期肿瘤患者进行肝移植治疗。3期患者，推荐可能根治的外科切除术，或者不可能根治的患者接受TACE治疗。4期患者，推荐接受索拉非尼系统性治疗，但这些患者肯定是临床试验的候选人。5期患者，推荐分为两组，早期但伴有严重肝硬化的5a期患者推荐肝移植，晚期侵袭性肿瘤的5b期患者推荐接受系统的支持治疗。对比BCLC分期系统推荐，HKLC分期系统推荐中位数总体生存率为16.6个月。如果这些患者接受BCLC分期系统推荐法总体生存率少于9个月。所以遵循HKLC分期系统推荐，HCC患者可增加一倍的生存时间。我们也发现一些亚组患者接受HKLC系统推荐相比BCLC系统推荐可获得超过5年的生存。

　　Dr. Thomas Yau: We have classified our HCC patients into five stages with specific treatment recommendations. Stages 1 and 2 would receive curative therapy by surgical resection, curative ablative therapy or in the case of early tumors, they can undergo transplantation. Stage 3 patients are recommended to receive a possible curative surgical resection or where that is not possible, receive TACE. For patients in Stage 4, we recommend they receive systemic therapy, which is currently sorafenib, but they are certainly candidates for clinical trials. For those in Stage 5, we have divided the stage into two groups. Stage 5a patients have an early tumor but with severe underlying liver cirrhosis, so liver transplantation would be the recommendation. Stage 5b patients have advanced disease with aggressive tumors, so these patients are recommended to receive symptomatic supportive care. We have also compared the HKLC Staging System recommendations to the BCLC Staging System recommendations. We find that patients receiving treatment according to our recommendations, the median overall survival is 16.6 months. If they receive treatment recommendations following the BCLC algorithm, their overall survival is <9 months. So following our recommendations, our HCC patients can potentially doubled their survival time. We found certain subgroups of patients who received treatment recommendations according to the HKLC scheme had much better 5-year survival than BCLC.

　　《国际肝病》：请您介绍下香港目前肝癌的发病情况和治疗现状？

　　邱宗祥博士：引起肝细胞癌的最主要原因为乙型肝炎病毒感染，香港8%的患者是由于HBV感染，与中国大陆相似。香港的治疗方式与中国大陆也相似。如果患者是可切除的肿瘤，推荐外科手术切除。如果患者是肝硬化及可能进行肝移植，则推荐进行肝移植。对于不能手术的患者，推荐TACE（经导管肝动脉化疗栓塞）治疗。不能接受手术的转移患者不适合肝移植且不能接受局部手术治疗，这些患者可接受索拉非尼治疗或参与临床试验。香港每年会有大约1500例新发HCC患者。

　　Dr. Thomas Yau: The majority of hepatocellular carcinoma cases are due to hepatitis B infection. Eighty percent of cases in Hong Kong are due to HBV and I believe that is very similar in mainland China. We also have similar modalities of treatment as China. If a patient has a resectable tumor, we recommend surgical resection. If the patient has cirrhosis and is potentially transplantable, we would recommend transplantation. For those patients that are not surgical candidates, we recommend TACE. If a metastatic patient has an unresectable tumor, is not transplantable and cannot receive any local operative therapy, these patients would receive sorafenib or treatment in a clinical trial. Each year we see around 1500 new cases of HCC in Hong Kong.

　　《国际肝病》：对于不能接受手术切除的肝癌患者，您是如何治疗？

　　邱宗祥博士：对于不能接受手术切除的肝癌患者，我需要确定是否存在血管侵犯或转移。如果有血管侵犯，建议患者接受非手术治疗，大部分是TACE治疗。近年来在香港，我们一直用栓塞治疗不能手术切除的患者。如果不能接受TACE或栓塞的患者，会给予系统性治疗，通常使用索拉非尼或入组临床试验。香港有几个正在进行的HCC免疫治疗的临床试验。

　　Dr. Thomas Yau: If the patient is unresectable, I determine if there is any underlying vascular invasion or systemic metastases. If there is vascular invasion, I would suggest the patient receive non-operative therapy, mostly TACE. In recent years in Hong Kong, we have been using more radioembolization for unresectable tumors. If the patient with an unresectable tumor is not a candidate for TACE or radioembolization, we would give the patient systemic therapy, usually sorafenib or enrolment in clinical trials. We have several HCC immunotherapy trials ongoing in Hong Kong.

　　《国际肝病》：分子靶向治疗是目前肿瘤治疗的热点，您会倾向用于哪些肝癌患者，晚期不可切除患者，还是建议尽早应用？

　　邱宗祥博士：我对晚期患者使用分子靶向治疗持保留意见。早期阶段应用靶向治疗已经进行了临床试验，部分是辅助治疗，例如索拉非尼与安慰剂对照的STORM试验，结果是阴性的。这显示分子靶向治疗可能不适用于早期患者。分子靶向治疗不是HCC的最优选择，因为即使在晚期患者，其应答率也低于5%且只有三分之一患者从中获益，即便使用索拉非尼中位数总体生存率也低于8个月。所以分子靶向治疗不应单独用于HCC管理。在香港，免疫治疗正显示出良好的前景，特别是使用PD-1抑制剂，我们是这些临床试验的中心之一。对比分子靶向治疗策略获益少，我们看到患者正从免疫治疗策略中获得显著收益。

　　Dr. Thomas Yau: I reserve the molecular targeted therapies for patients with advanced disease. There have been trials with the targeted agents in the early disease setting, particularly the adjuvant setting, such as the STORM trial comparing the use of sorafenib versus placebo, and that was a negative trial. That would indicate that molecular surgery may not be useful in early stage disease. Molecular therapy is still not optimal for HCC, because even in advanced cases, the response rate is <5% and only one-third of patients derive any benefit. Even on sorafenib, the median overall survival for these patients is <8 months. So molecular therapy alone should not be the only approach for the management of HCC. Immunotherapy is showing some promising results in HCC particularly using anti-PD-1, and in Hong Kong, we are one of the major centers involved in these trials. We are seeing patients derive significant benefit from this strategy compared to very little benefit being derived from molecular targeted therapy