原发性肝癌综合治疗的进展和热点

Progress and hot spots of comprehensive treatment for primary liver cancer

原发性肝癌(本文特指肝细胞癌,以下简称肝癌)的治疗原则是以手术为主的综合治疗。围绕提高根治性手术切除率和降低术后复发率等难题,肝癌的转化治疗、新辅助治疗和术后辅助治疗应运而生,极大地丰富了综合治疗的内涵,也成为研究热点。肝癌侵袭转移性强且常合并肝硬化等,综合治疗必不可少,但因手术适应证仍存在争议、个体间异质性大等原因,三种治疗方式尤其是转化治疗和新辅助治疗在概念和治疗方式上并非泾渭分明。治疗目标不同导致治疗方式选择、疗程长短和评估标准等也不同。结合临床实践,笔者分类论述肝癌的转化治疗、新辅助治疗和术后辅助治疗等最新进展和热点问题,期待开展更多研究获得临床循证医学证据规范综合治疗,从而成为提高肝癌诊断与治疗效果的突破口。

The treatment principle for primary liver cancer referring as hepatocellular carcinoma(HCC)in this article is comprehensive treatment based on radical hepatectomy.Focusing on improving the resection rate and reducing the recurrence rate after operation,the conversion therapy,preoperative neoadjuvant therapy and postoperative adjuvant therapy have emerged to become potentially curative strategies and research hotspots.HCC is highly invasive and often complicated with cirrhosis,so comprehensive treatment is essential for better prognosis.However,due to the controversy of surgical indications and heterogeneity among individuals,the concepts and treatment methods of above three therapies,especially between the conversion therapy and the preoperative neoadjuvant therapy,remain overlap and puzzle sometimes.Moreover,because of the different therapy goals,the above three therapies are different in the selection of treatment methods,duration of therapy and evaluation criteria.Based on clinical practice,the authors investigate the progress and hot spots of the conversion therapy,preoperative neoadjuvant therapy and post-operative adjuvant therapy of HCC,expecting more clinical evidence-based medicine to standardize the development of comprehensive treatment,so as to become a breakthrough to improve the diagnosis and treatment of HCC.