肝细胞癌新辅助治疗的现状与展望

倪志松; 温钧涵; 赵伟伟; 于守君; 郝亮; 成雨; 刘歆

doi:10.3969/j.issn.1001-5256.2023.11.027

肝细胞癌新辅助治疗的现状与展望

DOI: 10.3969/j.issn.1001-5256.2023.11.027

倪志松^1a,
温钧涵²,
赵伟伟^1b,
于守君^1c,
郝亮^1c,
成雨^1c,
刘歆^3, , ,

1a.
滨州医学院烟台附属医院国资处，山东烟台 264001
1b.
滨州医学院烟台附属医院中医科，山东烟台 264001
1c.
滨州医学院烟台附属医院肝胆胰脾外科，山东烟台 264001
2.
山东中医药大学第一临床医学院，济南 250011
3.
烟台市中医医院肿瘤一科，山东烟台 264001

基金项目:

国家自然科学基金 (81903790);

山东省中医药科技项目 (Q-2023109)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：倪志松负责课题设计及论文撰写；温钧涵、赵伟伟、郝亮、于守君、成雨参与论文查阅及修改论文；刘歆负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
刘歆， tanluzhe2888@163.com （ORCID： 0000-0002-0082-9439）

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出版历程
- 收稿日期: 2023-02-14
- 录用日期: 2023-02-28
- 出版日期: 2023-11-28

Neoadjuvant therapy for hepatocellular carcinoma： Current situation and prospects

Zhisong NI^1a,
Junhan WEN²,
Weiwei ZHAO^1b,
Shoujun YU^1c,
Liang HAO^1c,
Yu CHENG^1c,
Xin LIU^{3
, ,
,}

1a.
Department of State Capital，Yantai Affiliated Hospital of Binzhou Medical College，Yantai，Shandong 264001，China
1b.
Department of Traditional Chinese Medicine，Yantai Affiliated Hospital of Binzhou Medical College，Yantai，Shandong 264001，China
1c.
Minimally Invasive Center for Hepatobiliary，Pancreatic and Splenic Surgery，Yantai Affiliated Hospital of Binzhou Medical College，Yantai，Shandong 264001，China
2.
The First Clinical Medical College of Shandong University of Traditional Chinese Medicine，Jinan 250011，China
3.
First Department of Oncology，Yantai Hospital of Traditional Chinese Medicine，Yantai，Shandong 264001，China

Research funding:

National Natural Science Foundation of China Program (81903790);

Shandong Traditional Chinese Medicine Technology Project (Q-2023109)

More Information

Corresponding author: LIU Xin， tanluzhe2888@163.com （ORCID： 0000-0002-0082-9439）

摘要

摘要: 肝细胞癌（HCC）是癌症相关死亡的主要原因，手术切除是重要的根治性治疗手段，但术后高复发率仍是当前亟待解决的问题。新辅助治疗可降低术后高复发率，既往因缺乏有效的治疗手段，肝癌的新辅助治疗临床获益甚微。当前基于免疫检查点抑制剂的联合治疗，因其高有效率改变了晚期HCC患者的治疗格局。这促使研究者重新审视HCC的新辅助治疗策略，期望通过新辅助治疗能提供新的机会，降低术后复发率，提高治疗后的生存率。本文就HCC新辅助治疗的现状和前景及一些热点问题进行探讨，以期为其治疗提供更多思路。
- 癌，肝细胞 /
- 新辅助治疗 /
- 治疗结果
Abstract: Hepatocellular carcinoma （HCC） is a major cause of cancer-related death， and surgical resection remains an important method for radical treatment， but it is urgently needed to solve the problem of high postoperative recurrence rate. Neoadjuvant therapy can reduce the high recurrence rate after surgery， and there are little benefits from neoadjuvant therapy for HCC due to a lack of effective treatment methods in the past. At present， combination therapy based on immune checkpoint inhibitors has a relatively high response rate and has thus changed the treatment landscape for patients with advanced HCC. This urges investigators to reexamine the neoadjuvant treatment strategies for HCC， and it is expected that neoadjuvant therapy can provide new opportunities， reduce the postoperative recurrence rate， and improve the survival rate after treatment. This article discusses the current status and prospects of neoadjuvant therapy for HCC and related hot topics， so as to provide more ideas for exploring neoadjuvant therapy for HCC.
- Carcinoma， Hepatocellular /
- Neoadjuvant Therapy /
- Treatment Outcome

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图 1 肝癌领域与外科相关的治疗方式

Figure 1. Concepts related to surgery for HCC

下载: 全尺寸图片幻灯片

表 1 肝癌局部治疗模式的技术优势对比

Table 1. Comparison of technical advantages of locoregional therapy for HCC

策略	技术	应用和优势	不良反应
TACE	c-TACE/d-TACE	转化、桥接治疗	栓塞综合征、肝功能损伤
TARE	⁹⁰Y放射微球	合并PVTT/增加对侧肝叶体积	栓塞综合征、肝功能损伤、放射性肝损害
放疗	3-DCRT/SBRT/IMRT	合并PVTT	放射性肝损害
HAIC	FOLFOX	合并PVTT/降低微血管侵犯	疼痛/骨髓抑制/消化道症状
注：3-DCRT，三维适形放疗；SBRT，立体定向放疗；IMRT，调强放疗。‍不同研究之间结果不可直接对比。

下载: 导出CSV

表 2 肝癌新辅助在研的局部治疗方案

Table 2. Selected studies on the use of neoadjuvant locoregional therapy

治疗方案	方法	纳入人群	主要研究终点	次要研究终点
NCT04025437	放疗	Ⅰ型PVTT	总生存期	RFS
NCT04587739	SBRT	3～8 cm单病灶	退出率	放射毒性、总生存期、DFS、手术情况
NCT03469479	HAIC	超米兰可切除	总生存期	RFS、不良反应
NCT0385193	HAIC	超米兰BCLC A/B	总生存期	RFS、PFS、复发率
NCT03368651	HAIC	PVTT	总生存期	RFS、PFS、复发率
NCT04181931	HAIC+TACE	PVTT	PFS	总生存期
NCT04424043	HAIC+TACE	BCLC B	PFS	总生存期
NCT0477794	HAIC+TACE	BCLC A高危	PFS	总生存期

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