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Downstaging treatment of hepatocellular carcinoma with portal vein tumor thrombus
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摘要:
肝细胞癌伴门静脉癌栓发生率高,病情进展快,现有治疗方法有限且效果不佳。虽然国外指南推荐索拉非尼为唯一治疗手段,但临床研究显示部分患者,尤其是伴癌栓侵犯至门静脉一级或二级分支的患者（程氏分型Ⅰ/Ⅱ型）,通过手术切除可以取得比其他非手术疗法更好的效果。然而临床实践中相当一部分患者由于病灶范围较广无法根治性切除,或者由于癌栓侵犯到门静脉主干（程氏Ⅲ型）,术后癌栓残留可能性高,需要通过降期切除的方法改善预后。研究发现通过新辅助三维适形放疗、经肝动脉钇-90微球放射性栓塞、肝动脉灌注化疗等姑息性治疗方法,部分患者（5. 7%～26. 5%）可出现门静脉癌栓消退乃至消失、肿瘤体积缩小、卫星灶消失等现象,从而使病灶降期,提高手术切除率并延长患者生存时间。多学科综合治疗对于进一步提高肝细胞癌伴门静脉癌栓患者的降期切除率至关重要。
Abstract:Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression,and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines,studies have shown that some patients may achieve a better outcome via surgical treatment,especially those with tumor thrombus in the first-or second-order branches of the portal vein( type Ⅰ/Ⅱ thrombus according to Cheng's classification). However in clinical practice,a large proportion of patients cannot undergo radical resection due to extensive lesions,or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein( type Ⅲ according to Cheng's classification),and therefore,downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy,( 90) Y-loaded microsphere radioembolization,and hepatic arterial infusion chemotherapy,some patients may achieve regression or disappearance of portal vein tumor thrombus,tumor shrinkage,and disappearance of satellite lesions,which helps to achieve tumor downstaging,increase surgical resection rate,and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.
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Key words:
- carcinoma,hepatocellular /
- portal vein tumor thrombus /
- therapeutics
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[1] TORRE LA,BRAY F,SIEGEL RL,et al. Global cancer statistics,2012[J]. CA Cancer J Clin,2015,65(2):87-108. [2] CHEN W,ZHENG R,BAADE PD,et al. Cancer statistics in China,2015[J]. CA Cancer J Clin,2016,66(2):115-132. [3] WINGO PA,TONG T,BOLDEN S. Cancer statistics,1995[J]. CA Cancer J Clin,1995,45(1):8-30. [4] JEMAL A,BRAY F,CENTER MM,et al. Global cancer statistics[J]. CA Cancer J Clin,2011,61(2):69-90. [5] CHENG S,CHEN M,CAI J,et al. Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus:2016 edition[J].Oncotarget,2017,8(5):8867-8876. [6] LLOVET JM,BRU'C,BRUIX J. Prognosis of hepatocellular carcinoma:The BCLC staging classification[J]. Semin Liver Dis,1999,19(3):329-338. [7] European Association for the Study of the Liver. EASL clinical practice guidelines:Management of hepatocellular carcinoma[J]. J Hepatol,2018,69(1):182-236. [8] BRUIX J,SHERMAN M,American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma:An update[J]. Hepatology,2011,53(3):1020-1022. [9] NG J,WU J. Hepatitis B-and hepatitis C-related hepatocellular carcinomas in the United States:Similarities and differences[J]. Hepat Mon,2012,12(10 HCC):e7635. [10] UTSUNOMIYA T,SHIMADA M,KUDO M,et al. A comparison of the surgical outcomes among patients with HBV-positive,HCV-positive,and non-B non-C hepatocellular carcinoma:A nationwide study of 11,950 patients[J]. Ann Surg,2015,261(3):513-520. [11] WANG K,GUO WX,CHEN MS,et al. Multimodality treatment for hepatocellular carcinoma with portal vein tumor thrombus:A large-scale,multicenter,propensity mathching score analysis[J]. Medicine(Baltimore),2016,95(11):e3015. [12] LIANG L,CHEN TH,LI C,et al. A systematic review comparing outcomes of surgical resection and non-surgical treatments for patients with hepatocellular carcinoma and portal vein tumor thrombus[J]. HPB(Oxford),2018,20(12):1119-1129. [13] KOKUDO T,HASEGAWA K,MATSUYAMA Y,et al. Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion[J]. J Hepatol,2016,65(5):938-943. [14] LAU WY,LAI EC. Salvage surgery following downstaging of unresectable hepatocellular carcinoma—a strategy to increase resectability[J]. Ann Surg Oncol,2007,14(12):3301-3309. [15] SHUQUN C,MENGCHAO W,HAN C,et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein[J]. Hepatogastroenterology,2007,54(74):499-502. [16] HEN XP,QIU FZ,WU ZD,et al. Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma[J]. Ann Surg Oncol,2006,13(7):940-946. [17] YU JI,PARK HC. Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis[J]. World J Gastroenterol,2016,22(30):6851-6863. [18] ZHANG L,LI N,FENG S,et al. Portal vein tumor thrombus is more sensitive to irradiation[J]. Int J Clin Exp Med,2017,10(3):4486-4496. [19] WADA H,SASAKI Y,YAMADA T,et al. Successful preoperative treatment for hepatocellular carcinoma with tumor thrombus in the major portal branch by three-dimensional conformal radiation therapy—two case reports[J]. Hepatogastroenterology,2005,52(62):343-347. [20] LI N,FENG S,XUE J,et al. Hepatocellular carcinoma with main portal vein tumor thrombus:A comparative study comparing hepatectomy with or without neoadjuvant radiotherapy[J]. HPB(Oxford),2016,18(6):549-556. [21] WEI X,JIANG Y,ZHANG X,et al. Neoadjuvant three-dimensional conformal radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus:A randomized,open-label,multicenter controlled study[J]. J Clin Oncol,2019,37(24):2141-2151. [22] YAMADA K,IZAKI K,SUGIMOTO K,et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma[J]. Int J Radiat Oncol Biol Phys,2003,57(1):113-119. [23] YOON SM,LIM YS,WON HJ,et al. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein:Long-term patient outcomes[J]. Int J Radiat Oncol Biol Phys,2012,82(5):2004-2011. [24] YOON SM,RYOO BY,LEE SJ,et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion:A randomized clinical trial[J]. JAMA Oncol,2018,4(5):661-669. [25] SHUI Y,YU W,REN X,et al. Stereotactic body radiotherapy based treatment for hepatocellular carcinoma with extensive portal vein tumor thrombosis[J]. Radiat Oncol,2018,13(1):188. [26] CHOI JY,YU JI,PARK HC,et al. The possibility of radiotherapy as downstaging to living donor liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus[J].Liver Transpl,2017,23(4):545-551. [27] GARIN E,ROLLAND Y,EDELINE J,et al. Personalized dosimetry with intensification using 90Y-loaded glass microsphere radioembolization induces prolonged overall survival in hepatocellular carcinoma patients with portal vein thrombosis[J]. J Nucl Med,2015,56(3):339-346. [28] EDELINE J,CROUZET L,CAMPILLO-GIMENEZ B,et al.Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis[J]. Eur J Nucl Med Mol Imaging,2016,43(4):635-643. [29] YOON HI,SONG KJ,LEE IJ,et al. Clinical benefit of hepatic arterial infusion concurrent chemoradiotherapy in locally advanced hepatocellular carcinoma:A propensity score matching analysis[J]. Cancer Res Treat,2016,48(1):190-197. [30] CHONG JU,CHOI GH,HAN DH,et al. Downstaging with localized concurrent chemoradiotherapy can identify optimal surgical candidates in hepatocellular carcinoma with portal vein tumor thrombus[J]. Ann Surg Oncol,2018,25(11):3308-3315. [31] NAGAMATSU H,SUMIE S,NIIZEKI T,et al. Hepatic arterial infusion chemoembolization therapy for advanced hepatocellular carcinoma:Multicenter phase II study[J]. Cancer Chemother Pharmacol,2016,77(2):243-250. -
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