肝细胞癌术后辅助治疗的选择和争议

Selection and controversy of adjuvant therapy after hepatocellular carcinoma

手术切除是肝细胞癌(hepatocellular carcinoma,HCC)的重要根治手段,然而其术后的高复发率限制了患者的生存获益。HCC术后患者是否应当接受辅助治疗、能否从辅助治疗中获益仍然存在争议。已有研究显示HCC术后辅助治疗仅能使合并高危复发因素的患者获益,而对整体HCC术后患者获益不显著。现有临床研究入组标准主要依据HCC术后的高危复发因素,但不同研究之间差异较大。相关临床研究提示了多种辅助手段对合并特定高危因素患者的有效性,但仍然缺乏高级别循证证据。笔者认为,术后辅助治疗应建立在患者良好的肝功能与合并高危复发因素之上,其开展需综合考虑患者的长期获益与其对后续治疗的影响,避免过度应用。

Surgical resection is an important curative method for hepatocellular carcinoma(HCC).however,the high rate of postoperative recurrence limits the survival benefit for patients.Whether HCC patients should receive adjuvant therapy and whether they can benefit from it remain controversial.Previous studies have shown that adjuvant therapy after HCC surgery only benefits patients with high-risk recurrence factors,but the overall benefit for all HCC patients is not significant.Currently,there are numerous adjuvant treatment options for postoperative HCC,including targeted drugs,immunotherapy,interventional therapy,and radiation therapy,but there are significant differences in the inclusion criteria and effectiveness among different studies.Overall,the effectiveness of adjuvant therapy after surgery is established on the basis of good liver function in patients and the presence of high-risk recurrence factors.Its implementation should consider the long-term benefits for patients and its impact on subsequent treatment,in order to avoid excessive use.