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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

引用本文:
Citation:

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
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)

Neoadjuvant therapy for hepatocellular carcinoma: Current situation and prospects

Research funding: 

National Natural Science Foundation of China Program (81903790);

Shandong Traditional Chinese Medicine Technology Project (Q-2023109)

More Information
  • 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。

     

  • 图  1  肝癌领域与外科相关的治疗方式

    Figure  1.  Concepts related to surgery for HCC

    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
    下载: 导出CSV
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