肝细胞癌术后辅助治疗的策略与进展

Strategy and progress of postoperative adjuvant treatment in hepatocellular carcinoma

肝细胞癌是严重威胁我国人民生命健康的重大疾病,乙型肝炎病毒慢性感染是造成我国肝细胞癌发生的最主要病因。根治性外科手术是肝细胞癌患者有望取得长期生存的重要治疗手段,但术后的高复发转移率显著影响远期预后。肝细胞癌术后复发的特点呈现双峰模式,早期复发会导致更高的死亡率和更差的生存预后。术后辅助治疗有助于减少肿瘤复发率而提升整体疗效,但国内外尚无统一规范的术后辅助治疗方案。抗病毒治疗、介入治疗、靶向治疗、免疫治疗、放射治疗、中医药治疗等对于降低肝细胞癌术后复发、延长总体生存期可能具有一定的作用。如何准确地评估与筛选肝细胞癌术后高复发风险人群、选择最佳的术后辅助治疗方式与时机、决定术后辅助治疗的持续时间等关键问题仍需高质量的基础研究突破和多中心临床随机对照研究证实。本文将基于最新的研究进展并结合我国肝细胞癌发生的现实情况,就肝细胞癌术后复发的特点、辅助治疗策略的选择和面临的问题等进行讨论。

Hepatocellular carcinoma is a significant disease that seriously threatens the life and health of our people,and chronic hepatitis B virus infection is the most important cause of hepatocellular carcinoma in China.Radical surgery is an essential treatment for hepatocellular carcinoma patients who are expected to achieve long-term survival.However,the high recurrence and metastasis rate after surgery significantly affects the long-term prognosis.Postoperative recurrence of hepatocellular carcinoma is characterized by a bimodal pattern,with early recurrence leading to higher mortality and poorer survival prognosis.Postoperative adjuvant therapy can help to reduce the recurrence rate and improve the overall efficacy,but there is no standardized postoperative adjuvant therapy regimen at home and abroad.Studies have shown that antiviral therapy,interventional therapy,targeted therapy,immunotherapy,radiation therapy,and traditional Chinese medicine may have a specific effect on reducing the recurrence of hepatocellular carcinoma after surgery and prolonging overall survival.Key issues such as how to accurately assess and screen the population with a high risk of postoperative recurrence of hepatocellular carcinoma,select the best postoperative adjuvant treatment modality and timing and determine the duration of postoperative adjuvant treatment still need to be confirmed by high-quality fundamental research breakthroughs and multicenter clinical randomized controlled studies.In this article,the authors will discuss the characteristics of postoperative recurrence of hepatocellular carcinoma,the selection of adjuvant treatment strategies,and the problems faced based on the latest research progress and in light of the reality of hepatocellular carcinoma occurrence in China.