综合治疗时代晚期肝癌治疗的全局观

Holistic view of managing advanced liver cancer in the era of comprehensive treatment

晚期肝癌严重威胁我国人民的生命和健康。肝脏的解剖结构及生理功能决定了肝癌具有天然的化疗耐药的特点。目前已有多种靶向治疗药物获批用于晚期肝癌的一线和二线治疗。免疫治疗的出现使肝癌的治疗进入新的时代。靶向与免疫治疗药物在机制上具有协同作用,而且二者的联合使用已在临床上使更多的晚期肝癌病人获益。同时,在靶向联合免疫的全身治疗基础上加用恰当的局部治疗,使部分病人获得了更长的生存期甚至治愈的机会。这种全身治疗联合局部治疗的综合治疗理念已被广泛接受。由于晚期肝癌病人的身体一般状况、肝脏基础疾病状态不同,为了使每个病人获得最大的临床获益,应该在综合治疗理念下,根据病人的具体情况个体化地定制治疗方案,并在多学科诊疗模式下对病人进行全程管理。

Advanced liver cancer is a serious threat and a heavy disease burden in our country.The anatomical structures and physiological functions of liver determine that liver cancer has the characteristics of natural chemotherapeutic resistance.Currently a variety of targeted therapies have been approved for first/second-line treatment of advanced liver cancer.The emergence of immunotherapy has brought the treatment of liver cancer into a new era.Targeted and immunotherapy drugs have a synergistic effect in mechanism and the combined use of both has shown great benefits.At the same time,some patients may achieve a longer survival and even a chance of cure by taking appropriate local treatments plus systemic targeted therapy and immunotherapy.This comprehensive treatment concept of systemic therapy plus local therapy has been widely accepted.Due to different physical status and basic liver diseases of patients with advanced liver cancer,for maximizing the clinical benefits,treatment plans should be customized according to the specific patient conditions under the comprehensive treatment concept.And patients should be managed throughout by a multi-disciplinary treatment mode.