晚期肝癌和复发性肝癌治疗的研究进展

Progress of Treatments in Advanced or Recurrent Hepatocellular Carcinoma

肝细胞癌(HCC)是我国最常见的恶性肿瘤之一,70%继发于肝炎、肝硬变。虽然诊断技术的提高,使肝癌的早期发现成为可能,然而由于肝癌早期症状隐匿,大多数肝癌确诊时已处于中晚期。肝切除术是治疗肝细胞癌最常用的手段。对于一些不可切除的晚期肝细胞癌,可采用动脉化疗栓塞以及系统化疗等手段使肿瘤降期,当转变成可切除肝癌后,再行补救性肝切除延长患者的生存期。此外,对于剩余肝体积不足而无法行一期肝切除的患者,可以采用PVE、ALPPS等方法,在剩余肝脏体积增大后再行二期肝切除术。肝内肿瘤复发率高也是导致肝细胞癌预后差的重要因素。在局部治疗后,建议在保留肝功能的前提下重复治疗。相比局部消融和动脉化疗栓塞治疗等多种手段,肝切除术有最好的远期疗效。联合和重复不同的治疗手段可达到很好的总生存期。对于患有晚期不可切除肿瘤或复发癌的患者,应积极的发挥肝切除的作用,并联合其他非手术治疗手段以取得较好的预后。

Hepatocellular carcinoma（HCC） is one of the most commonly diagnosed malignancies in China. Seventy percent of HCC occurred secondary to hepatitis and cirrhosis. It is now available to discover HCC in an early stage due to advanced technology in diagnosis. However, most cases, which are diagnosed definitely as HCC, are in advanced stage. Hepatectomy is the most commonly treatment for HCC. In some advanced HCC, which not available for hepatectomy initially, down-stage treatments such as transarterial chemo-embolization, systemic chemotherapy can converse tumors to resectable HCC. Then salvage hepatectomy can be done to prolong patients＇ survival. In some cases which are considered unresectable because of small remnant liver volume, curative resection can be attempted after future liver remnant volume enlarged by two-stage techniques like PVE and ALPPS. Frequent intrahepatic tumor recurrence is a crucial event response for poor prognosis in HCC. Repeated treatments are recommended without hurting maintained liver function after local-regional therapy. Compared with ablation, transarterial chemoembolization and other local treatments, hepatectomy provides the best long-term outcomes. Hepatectomy combining with different treatments and repeated therapies can obtain a good overall survival. Hepatectomy should be positively used in advanced and recurrent hepatocellular carcinoma.