肝细胞癌综合治疗的现状和前景

谭运华; 商阳阳; 张涛; 李剑波; 郑明友

doi:10.3969/j.issn.1001-5256.2019.08.047

肝细胞癌综合治疗的现状和前景

DOI: 10.3969/j.issn.1001-5256.2019.08.047

中国科学院大学重庆市人民医院肝胆外科

基金项目:

重庆市技术创新与应用示范项目(CSTC2018JSCX-MSYBX0279)；

详细信息

中图分类号: R735.7
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- 被引次数: 0
出版历程
- 收稿日期: 2019-01-21
- 出版日期: 2019-08-20

Current status and perspectives of multimodality therapy for hepatocellular carcinoma

Department of Hepatobiliary Surgery, Chongqing People's Hospital, University of Chinese Academy of Sciences

Research funding:

摘要

摘要: 肝细胞癌(HCC)在全世界有很高的发病率和病死率,因为HCC发生发展的复杂性,到目前为止,HCC的管理策略尚未完全统一。特别近十年来,HCC的治疗方案已发展为以外科手术为主的多学科综合治疗。除了肝切除和肝移植以外,消融治疗是另外一种根治性治疗方法,目前针对肿瘤直径<3 cm且不能接受肝移植的肝癌患者,可作为一线治疗方案;肝动脉化疗栓塞术是针对不适合根治性治疗的中晚期肝癌的首选治疗方法,可联合消融治疗和化疗,显示出良好的疗效;对于诊断为晚期HCC或在其他治疗失败后进展到晚期HCC患者可以选择分子靶向治疗;细胞免疫治疗是HCC新型治疗方法,可以为进展性HCC患者带来有效的缓解率和生存获益。充分解析HCC各种治疗方法特点,制订个体化治疗方案,合理综合治疗HCC,以提高HCC整体疗效。
- 癌,肝细胞 /
- 治疗学 /
- 预后
Abstract: Hepatocellular carcinoma (HCC) has high morbidity and mortality rates worldwide, and due to the complexity of the development of HCC, the management strategy for HCC has not been completely unified. During the past decade, the treatment of HCC has developed into a multidisciplinary and multimodality therapy centered on surgical operation. Besides hepatectomy and liver transplantation, ablation therapy is another radical treatment, and at present, it can be used as the first-line treatment regimen for HCC patients who have a tumor diameter of < 3 cm and cannot undergo liver transplantation. Transarterial chemoembolization is the preferred treatment for advanced HCC not suitable for radical treatment. Molecular targeted therapy is mainly used in patients who are diagnosed with advanced HCC or progress to advanced HCC after treatment failures. Cellular immunotherapy is a new treatment for HCC and can help patients with progressive HCC to achieve good remission rate and survival benefit. A deep understanding of the features of each treatment method for HCC, development of individualized treatment regimens, and rational multimodality therapy for HCC can help to improve the overall therapeutic outcome of HCC.
- carcinoma, hepatocellular /
- therapeutics /
- prognosis

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参考文献(26)

[1] CHEN W, SUN K, ZHENG R, et al. Cancer incidence and mortality in China, 2014[J]. Chin Cancer Res, 2018, 30 (1) :1.

[2] TAN Y, JIANG J, WANG Q, et al. Radiofrequency ablation using a multiple-electrode switching system for hepatocellular carcinoma within the Milan criteria:Long-term results[J]. Int J Hyperthermia, 2018, 34 (3) :298-305.

[3] McGUIRE S. World Cancer Report 2014. Geneva, Switzerland:World Health Organization, International Agency for Research on Cancer, WHO Press, 2015[J]. Adv Nutr, 2016, 7 (2) :418-419.

[4] BRUIX J, LLOVET JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma[J]. Hepatology, 2002, 35 (3) :519-524.

[5] YAMASHITA YI, TAKETOMI A, ITOH S, et al. Long term favorable results of limited hepatic resections for patients with hepatocellular carcinoma:20 years of experience[J]. J Am Coll Surgeons, 2007, 205 (1) :19-26.

[6] LLOVET JM, SCHWARTZ M, MAZZAFERRO V. Resection and liver transplantation for hepatocellular carcinoma[J]. Semin Liver Dis, 2005, 25 (2) :181-200.

[7] MADDALA YK, STADHEIM L, ANDREWS JC, et al. Drop-out rates of patients with hepatocellular cancer listed for liver transplantation:Outcome with chemoembolization[J]. Liver Transpl, 2004, 10 (3) :449-455.

[8] YAO FY, BASS NM, ASCHER NL, et al. Liver transplantation for hepatocellular carcinoma:Lessons from the first year under the Model of End-Stage Liver Disease (MELD) organ allocation policy[J]. Liver Transpl, 2004, 10 (5) :621-630.

[9] TSOULFAS G, KAWAI T, ELIAS N, et al. Long-term experience with liver transplantation for hepatocellular carcinoma[J]. J Gastroenterol, 2011, 46 (2) :249-256.

[10] RAHMAN A, ASSIFI MM, PEDROSO FE, et al. Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A meta-analysis[J]. J Gastrointest Sur, 2012, 16 (10) :1897-1909.

[11] MINAMI Y, KUDO M. Radiofrequency ablation of hepatocellular carcinoma:Current status[J]. World J Radiol, 2010, 2 (11) :417-424.

[12] LENCIONI R, CROCETTI L. Local-regional treatment of hepatocellular carcinoma[J]. Radiology, 2012, 262 (1) :43-58.

[13] GERMANI G, PLEGUEZUELO M, GURUSAMY K, et al. Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma:A meta-analysis[J]. J Hepatol, 2010, 52 (3) :380-388.

[14] HASEGAWA K, AOKI T, ISHIZAWA T, et al. Comparison of the therapeutic outcomes between surgical resection and percutaneous ablation for small hepatocellular carcinoma[J].Ann Surg Oncol, 2014, 21 (3) :348-355.

[15] CHOI D, LIM HK, RHIM H, et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment:Long-term results and prognostic factors in a large single-institution series[J]. Eur Radiol, 2007, 17 (3) :684-692.

[16] SI TF, CHEN YJ, MA D, et al. Effect of preoperative transarterial chemoembolization on perioperative safety of patients with resectable hepatocellular carcinoma:A Meta-analysis[J].Chin J Dig Surg, 2017, 16 (5) :496-502. (in Chinese) 斯腾飞, 陈拥军, 马迪, 等.术前经导管动脉内化疗栓塞术对可切除性肝细胞癌围术期安全性影响的Meta分析[J].中华消化外科杂志, 2017, 16 (5) :496-502.

[17] YAMAGIWA K, SHIRAKI K, YAMAKADO K, et al. Survival rates according to the Cancer of the Liver Italian Program scores of 345 hepatocellular carcinoma patients after multimodality treatments during a 10-year period in a retrospective study[J]. J Gastroen Hepatol, 2008, 23 (3) :482-490.

[18] CUI YL. Targeted therapy for hepatocellular carcinoma[J].Chin J Dig Surg, 2018, 17 (5) :445-451. (in Chinese) 崔云龙.肝癌的靶向治疗[J].中华消化外科杂志, 2018, 17 (5) :445-451.

[19] ZHANG CY, ZHAO XX, LU ZM, et al. Research advances in sorafenib-induced apoptotic signaling pathways in liver cancer cells[J]. J Clin Hepatol, 2016, 32 (4) :816-820. (in Chinese) 张朝亚, 赵相轩, 卢再鸣, 等.索拉非尼诱导肝癌细胞凋亡信号通路的研究进展[J].临床肝胆病杂志, 2016, 32 (4) :816-820.

[20] LLOVET JM, RICCI S, MAZZAFERRO V, et al. Sorafenib in advanced hepatocellular carcinoma[J]. N Engl J Med, 2008, 359 (4) :378-390.

[21] FENG X, XU R, DU X, et al. Combination therapy with sorafenib and radiofrequency ablation for BCLC Stage 0-B1hepatocellular carcinoma:A multicenter retrospective cohort study[J]. Am J Gastroenterol, 2014, 109 (12) :1891-1899.

[22] KUDO M, UESHIMA K, TORIMURA T, et al. Randomized, open label, multicenter, phase II trial of transcatheter arterial chemoembolization (TACE) therapy in combination with sorafenib as compared with TACE alone in patients with hepatocellular carcinoma:TACTICS trial[J]. J Clin Oncol, 2018, 36 (15 Suppl) :4017.

[23] BRUIX J, QIN S, MERLE P, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE) :A randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2017, 389 (10064) :56-66.

[24] REN ZG. Immunotherapy for hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34 (7) :1371-1373. (in Chinese) 任正刚.肝细胞癌的免疫治疗[J].临床肝胆病杂志, 2018, 34 (7) :1371-1373.

[25] SANMAMED MF, CHEN L. A paradigm shift in cancer immunotherapy:From enhancement to normalization[J]. Cell, 2019, 176 (3) :677.

[26] EL-KHOUEIRY AB, SANGRO B, YAU T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate040) :An open-label, non-comparative, phase 1/2 dose escalation and expansion trial[J]. Lancet, 2017, 389 (10088) :2492-2502.

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