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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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