肝细胞癌术后转移复发:临床与相关基础研究进展

Recent progress in the studies on metastasis and recurrence of hepatocellular carcinoma

转移复发已成为进一步延长肝细胞癌病人生存、改善预后的主要障碍。其主要原因有二 :肝内播散或非同步多中心癌变。已发现许多因素与肝细胞癌转移复发有关 ,包括病人的一般状态、肿瘤大体病理学特征与病理组织学特征以及治疗相关因素等。近年来 ,随着对肿瘤生物学特征的进一步了解以及分子生物学技术的发展 ,已发现许多与肝细胞癌转移复发相关的分子标志物。已尝试包括术前、术后经导管动脉化疗栓塞、全身或局部化疗、生物治疗等多种新辅助或辅助疗法以降低或避免肝细胞癌术后复发。但其中仅少数研究被设计为随机对照试验。尚无足够证据提示这些新辅助或辅助疗法可使病人获益。大多数尚需进一步研究 ,其中生物疗法可能成为较为理想的途径。手术再切除、经动脉导管化疗栓塞、局部消融疗法、化疗、及放疗等多种疗法均可用于肝细胞癌转移复发的治疗。但很少有随机对照试验评价这些疗法对肝细胞癌转移复发的疗效。

Metastasis and recurrence after surgical resection of hepatocellular carcinoma(HCC)has become one major obstacle for further improving the survival and prognosis of HCC patients.Many factors,such as the patient's general conditions(age,sex,co-existing hepatitis,liver function,AFP level),macroscopic tumor morphology(tumor size,number,capsule status,intra- or extra-hepatic spreading,vessel invasion),and tumor pathohistological features,as well as treatment-related factors(surgical techniques,blood transfusion),have been determined as risk factors,and proven of predicting significance for HCC recurrence.In recent years,as the understanding of tumor biology and the development of molecular biology techniques,many molecular factors(biomarkers)have been developed.Various neoadjuvant or adjuvant therapeutic approaches including pre-operative transcatheter arterial chemoembolization(TACE),post-operative TACE,systemic or locoregional chemotherapy,immunotherapy,interferon,and acyclic retinoic acid have been hoped to decrease or eliminate recurrence of HCC.However,there is no evidence demonstrate benefit from the various neoadjuvant and adjuvant therapies investigated.Most of them deserve further evaluation by randomized control trial(RCT),and among of them,biotherapy could be an ideal strategy.Many kinds of treatment strategies,including surgical treatment(repeat resection and salvage transplantation),TACE,regional cancer therapies such as radiofrequency ablation(RFA),chemotherapy have been tried and proven to be potential helpful for the control of HCC recurrence and metastasis.However,there is few RCT to evaluate the effect of these modalities on the recurrence and metastasis of HCC.