肝癌的转化治疗策略

Conversion therapy strategies for hepatocellular carcinoma

  • 摘要: 手术切除是实现肝癌根治获得长期生存的重要手段,我国大部分肝癌患者初诊时即为中晚期,丧失了手术机会。近年来,随着局部治疗的进步、靶向药物的研发、免疫治疗的成功及联合治疗的协同效应,转化治疗应运而生,其已成为中晚期肝癌治疗新焦点。部分不可切除肝癌患者经过转化治疗后肝脏功能改善、剩余肝脏体积增大、肿瘤负荷减少,为序贯根治性手术提供了可能,延长了患者生存时间。目前,靶向联合免疫治疗模式及局部联合系统治疗模式是国内常用、适用范围较广的转化治疗模式。笔者认为:随着转化治疗的理念不断拓展,如何优化多种治疗模式,筛选最佳受益患者,把握手术时机和指征,提高转化率,保证手术的安全性和远期疗效仍需更多的临床证据支持,值得进一步探讨和研究。

     

    Abstract: Hepatectomy is the main optimal curative treatment of hepatocellular carci-noma (HCC) to achieve long‑term survival. However, most patients in China do not fulfill the criteria for surgery due to the intermediate-advanced stage of HCC at their initial diagnosis. With the promising advances in locoregional and systematic therapies, development of targeted drugs, success of immunotherapy, as well as the emergence of the therapeutic alliance, conversion therapy has well developed nowadays and become a hotspot in recent years. A part of unresectable HCC patients have afforded sequent radical surgery opportunities and prolonged the overall survival through improving liver function, increasing the residual liver volume, and minimizing tumor volume. At present, target therapy combined immunotherapy, local therapy combined systemic therapy are commonly used and widely applicable conversion therapy modes in China. Based on expansion of conversion therapy concepts, more high‑level evidences are needed to exploit the full potential of conversion treatment strategies, accurately select candidates, determine the timing of surgery, improve conversion rate, guarautee the safety and long‑term efficacy, which requires further investigation and research.

     

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