肝细胞癌切除术后复发的原因与防治策略

Postoperative recurrent factors and therapeutic and preventive strategies for hepatocellular carcinoma

肝细胞癌(hepatocellular carcinoma,HCC)是临床上常见的恶性肿瘤之一,HCC切除术后3年复发率约为50%,5年复发率超过70%,居高不下的高复发率严重影响HCC患者手术疗效和长期生存,是导致HCC患者术后死亡的首要原因.HCC术后复发是一个多步骤、多环节、多因素和多分子参与的复杂过程,涉及机体、微环境和肿瘤组织三个方面因素,包括机体免疫力、局部pH值、间质压力、血管渗透压、炎性反应、肿瘤细胞黏附、细胞外基质降解、细胞迁移、细胞增殖和肿瘤血管形成等,与多个基因表达异常和相关分子功能改变密切相关,但HCC术后复发的分子机制仍未完全阐明,需要更深入的研究.HCC术后复发如何治疗直接影响HCC患者预后,涉及再次手术、肝移植、局部微创治疗、放疗、分子靶向药物、免疫和中医药治疗,单一治疗方法难以达到治愈或控制肿瘤进展,需要两种或两种以上治疗方法有机地联合,达到协同增效的治疗效果.针对患者的具体情况,分析其个体特性,结合临床医生的临床经验和最佳证据,采取个体化的治疗方案,选择合适的治疗方法是提高疗效的关键.对于存在高危复发因素的HCC患者,术后选择适当的治疗方法预防HCC复发,是降低HCC术后复发率,延长患者生存期的重要措施,才能使术后HCC患者最大程度获益.

Hepatocellular carcinoma(HCC)is one of the most common malignant tumors in China.The recurrence rate is about 50%at 3 years and over 70%at 5 years after hepatectomy for HCC.The high recurrence rate seriously affects the curative effect and long-term survival of patients with HCC,and is the primary cause of death after operation.Postoperative recurrence of HCC is a complex multi-step,multi-factorial process involving three factors:the body,microenvironment,and tumor tissue,which include body immunity,local pH value,interstitial pressure,vascular osmotic pressure,inflammatory reaction,tumor cell adhesion,extracellular matrix degradation,cell migration,cell proliferation,and tumor angiogenesis.HCC recurrence is closely related to abnormal gene expression and related molecular function changes,but the molecular mechanism has not been fully elucidated.How to treat the recurrence of HCC after operation directly affects the prognosis of patients with HCC,and treatments include reoperation,liver transplantation,local minimally invasive treatment,radiotherapy,molecular targeted drugs,immunotherapy,and traditional Chinese medicine treatment.It is difficult to cure or control tumor progression by a single therapy.Two or more therapeutic methods need to be combined organically to achieve a synergistic therapeutic effect.According to the specific situation of patients with HCC,it is key to analyze the individual characteristics of patients,to combine the clinical experience of clinicians and the best evidence,to adopt the individualized treatment plan,and to choose the appropriate treatment methods.For HCC patients with high-risk factors for recurrence,selecting the appropriate treatment is important to reduce the recurrence of HCC after operation and prolong the survival of patients.