合并门静脉血栓的肝细胞癌治疗进展

Treatment Progress of Hepatocellular Carcinoma with Portal Vein Thrombosis

虽然肝细胞癌(HCC)治疗取得了长足进步,但处理合并门静脉血栓(PVT)的HCC仍具挑战性。在确诊的HCC患者中有10%~40%存在PVT,而其治疗方案却非常有限。目前的指南主要介绍了索拉非尼对合并PVT晚期HCC的治疗,但手术、动脉化疗栓塞、外放射治疗、放射性栓塞、动脉灌注化疗、联合治疗仍在使用,且一些新兴的疗法(如免疫治疗剂和溶瘤病毒)也正在研究中。故对于合并PVT的HCC来说,联合索拉非尼的局部治疗仍是一个值得积极研究的领域,今后需开展和进一步验证有效的联合治疗方案,并将其作为临床努力的方向。

Despite advances in the treatment of hepatocellular carcinoma( HCC),managing HCC with portal vein thrombosis( PVT) remains challenging. PVT is present in 10%-40% of HCC cases at the time of diagnosis and its therapeutic options are very limited. Current guidelines mainly recommend sorafenib for advanced HCC with PVT,but surgery,transarterial chemoemolization,external radiation therapy,radioembolization,transarterial infusion chemotherapy,and combination therapy are also still used. Furthermore,several new emerging therapies( such as the administration of immunotherapeutic agents and oncolytic viruses) are under investigation. As for HCC with PVT,local treatment combined with sorafenib is still an active research field,effective combination therapy should be carried out and verified in the future which will be the direction for the clinical practice.