图1 肝癌根治性切除术后辅助治疗路线图 注:1)针对乙肝背景的肝癌患者术后需要继续行抗乙肝病毒治疗,针对丙肝活动期患者需要进行规范性抗丙肝病毒治疗;2)低危:通常指不合并复发危险因素,如单个肿瘤、肿瘤长径≤5 cm、无微血管侵犯;3)复发风险因素包括但不限于:肿瘤多发、肿瘤长径>5 cm、Edmondson Ⅲ~Ⅳ级、微血管或大血管侵犯、淋巴结转移、AFP和DCP持续异常;4)如肝功能恢复良好(肝功能Child-Pugh分级A级),可尽早开始辅助治疗,系统性抗肿瘤治疗持续时间通常为6~12个月;5)若超声检查发现疑似病灶或血清AFP和(或)DCP升高,则进一步行肝脏增强CT或增强MRI检查(建议至少每3个月复查增强CT或MRI)。同时,酌情行肺部CT平扫、骨骼放射性核素CT扫描、头颅MRI或CT、全身PET/CT扫描检查,以明确是否存在肝外转移Fig.1 Postoperative adjuvant treatment algorithm after radical resection of HCC Note: 1) For patients with HCC associated with hepatitis B virus infection, antiviral therapy against hepatitis B virus should be continued after surgery, and for patients with active hepatitis C virus infection, standardized anti-hepatitis C virus therapy is recommended; 2) Low risk generally refers to the absence of recurrence risk factors, such as a solitary tumor, maximum tumor diameter ≤5 cm, and no microvascular invasion; 3) Risk factors for recurrence include, but are not limited to, multiple tumors, maximum tumor diameter >5 cm, Edmondson grade Ⅲ-Ⅳ, microvascular or macrovascular invasion, lymph node metastasis, and persistently elevated AFP and DCP levels; 4) If liver function recovers well (Child-Pugh class A), adjuvant therapy may be initiated as early as possible, and the duration of systemic antitumor therapy is usually 6-12 months; 5) If ultrasonography reveals suspected lesions or if serum AFP and/or DCP levels are elevated, contrast-enhanced liver CT or MRI should be performed for further evaluation (contrast-enhanced CT or MRI is recommended at least every 3 months), and meanwhile, non-contrast chest CT, bone radionuclide scintigraphy, brain MRI or CT, and whole-body PET/CT may be performed as appropriate to determine the presence of extrahepatic metastases