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
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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。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.
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Key words:
- Carcinoma, Hepatocellular /
- Neoadjuvant Therapy /
- Treatment Outcome
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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。 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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