肝癌外科治疗理念的革新与挑战

Concept innovations and challenges in surgical treatment of hepatocellular carcinoma

肝癌的治疗是以手术为中心的综合治疗。由于起病隐匿,仅1/3左右的初诊患者有机会接受根治性切除手术或肝移植。学术界对于选择腹腔镜还是传统开放肝切除,解剖性还是非解剖性肝切除的争议仍未停止。另外,在以酪氨酸激酶抑制剂为代表的靶向药物,和以PD-1单抗为代表的免疫检查点抑制剂问世之后,肝癌的围手术期辅助治疗迎来了一个崭新的时代。国内众多中心报道了对初始不可切除的中晚期肝癌患者行术前转化治疗的良好效果,为改善此类患者的预后带来了新的希望;而对初始可切除肝癌患者术前新辅助治疗、肝癌患者术后辅助治疗价值的研究也在积极开展中。更有学者基于辅助治疗手段的进步,提出肝癌无疾病证据状态的治疗策略。总之,目前肝癌的治疗模式已经开始向肝转移性结直肠癌的治疗模式转变,但其中仍有大量悬而未决的问题亟待进一步临床研究的验证。本文聚焦目前肝癌外科治疗理念的革新与挑战。

For hepatocellular carcinoma(HCC), surgery-oriented comprehensive treatment is the mainstream approach. Due to the insidious onset, only about one third of the newly diagnosed patients have a chance to receive a radical resection or liver transplantation. There are still controversies regarding the selection of laparoscopic or open surgery, and anatomic or nonanatomic liver resection in the academic community. In addition, the advent of targeted drugs represented by tyrosine kinase inhibitors and the immune checkpoint inhibitors represented by PD-1 antibodies leads the perioperative adjuvant therapy of HCC into a new era. A number of domestic medical centers have reported favorable results in preoperative conversion therapy for patients with initially unresectable advanced HCC, which offers new hope for improving the prognosis of these patients. Moreover, studies are also being actively carried out to evaluate the values of the preoperative neoadjuvant therapy for patients with initially unresectable advanced HCC as well as the postoperative adjuvant therapy for HCC patients. Even more, scholars proposed the treatment strategies toward the achievement of no evidence of disease condition in HCC,according to the advances in adjuvant treatment modalities. In general, the therapeutic patterns for the treatment of HCC nowadays are already shifting toward those for the treatment of liver metastases from colorectal cancer. However, there are still a range of outstanding problems that urgently need to be validated by further clinical studies. This article focuses on the current situation of concept innovations and challenges in surgical treatment of HCC.