《靶向免疫联合局部治疗中晚期肝细胞癌中国专家共识》解读

Interpretation of the Chinese expert consensus on targeted-immune combination local therapy for advanced hepatocellular carcinoma

我国是肝细胞癌(HCC)高发国家,且发病率和病死率均居高不下。多数HCC患者在诊断时已经是中晚期,失去手术机会。靶向免疫联合(靶免联合)治疗及靶免联合局部治疗是近年来中晚期HCC治疗的热点,基于免疫检查点抑制剂为基础的联合治疗方案显著提高了中晚期HCC患者的疗效。但是不同医疗机构方案和经验差异较大,缺乏统一的共识及全程管理的模式可供参考。近期由中国医疗保健国际交流促进会肝脏肿瘤学分会、免疫学分会以及靶免联合局部治疗中晚期肝细胞癌中国专家共识协作组牵头制定并发布了《靶向免疫联合局部治疗中晚期肝细胞癌中国专家共识》,该共识对HCC行靶免联合局部治疗的定义、适用人群及管理、治疗方式的选择、转化为可根治性治疗的策略、肿瘤进展的治疗策略以及常见不良反应管理等多方面、多角度进行了详细阐述。在此,笔者对该共识中要点进行解读,并对共识如何适应当前的研究或实践的背景进行展望。

China is a high-incidence country for hepatocellular carcinoma(HCC),with consistently high rates of both morbidity and mortality.The majority of HCC patients are already in the advanced stages at the time of diagnosis,losing the opportunity for surgery.Combined targeted therapy and immunotherapy(targeted-immune combination)and targeted-immune combination local therapy have become the hot topic in the treatment of advanced-stage HCC in recent years.Combination therapy based on immune checkpoint inhibitors has significantly improved the efficacy for patients with advanced-stage HCC.However,there is a significant difference in treatment plans and experiences among different medical institutions,lacking a unified consensus and a model for comprehensive management as a reference.Recently,the Hepatic Oncology Branch and Immunology Branch of China International Exchange and Promotive Association for Medical and Health Care and the Expert Consensus Collaborative Group on Targeted-Immune Combination Local Therapy for Advanced Hepatocellular Carcinoma took the lead in formulating and releasing the Chinese expert consensus on targeted-immune combination local therapy for advanced hepatocellular carcinoma.This consensus provides detailed explanations from various perspectives on the definition of targeted-immune combination local therapy for HCC,the eligible population and management,the selection of treatment methods,strategies for converting unresectable tumors into resectable tumors,treatment strategies for tumor progression,and the management of common adverse reactions.Here,the authors interpret the key points of this consensus and look ahead to how the consensus can adapt to the current background of research or practice.