肝细胞癌系统性治疗的思考和探讨

Thinking and exploration on systemic treatment of hepatocellular carcinoma

肝细胞癌是肝脏最常见的恶性肿瘤,且一半以上的患者在就诊时已属中晚期,严重威胁着我国人民的生命健康。虽然手术切除仍是当前肝细胞癌患者获得治愈的唯一治疗手段,但是,低手术切除率和高术后复发率极大地限制了患者的生存获益。新近,随着系统性新药的不断成功研发和临床应用,靶向联合免疫等多模式治疗异军突起,打破了单一治疗模式的局限性,已成为肝细胞癌“手术为主综合治疗”的重要一角。肝细胞癌新辅助治疗、辅助治疗及转化治疗逐渐成为新的研究焦点,它们的成功有望进一步改善肝细胞癌患者的生存预后,但仍然面临诸多挑战。笔者梳理当前肝细胞癌一线系统性治疗方案,就其临床应用的特点和优势作一深入阐述。

Hepatocellular carcinoma is the most common malignant tumor of the liver,and more than half of the patients are in the middle and late stage,seriously threatening the life and health of the Chinese people.Although surgical resection remains the only treatment option for liver cancer patients to achieve a cure,the low surgical resection rate and high postoperative recurrence rate greatly limit the survival benefits of patients.Recently,with the continuous successful development and clinical application of systemic new drugs,multi-mode therapy such as TKIs combined ICIs has sprung up,breaking the limitations of a single treatment model,and has become an important corner of"surgery-based comprehensive treatment"for liver cancer.Neoadjuvant therapy,adjuvant therapy and conversion therapy have gradually become the focus of new research,and their success is expected to further improve the survival prognosis of patients with liver cancer,but there are still many challenges.The author reviews the current first-line systematic treatment of liver cancer,and elaborates on the characteristics and advantages of its clinical application.