摘要 近年来,肝癌的系统治疗进展迅速,新的免疫治疗药物、靶向药物不断涌现,新的治疗理念和治疗方案不断创新。但关于系统治疗应用于肝癌术前的方案选择和疗效分析,探讨相对较少。肝癌的新辅助系统治疗按其目的和后续手术方式可分为可切除性肝癌的新辅助系统治疗、不可切除肝癌的转化治疗和肝移植术前的降期或桥接治疗。新辅助系统治疗策略的制定需基于术前诊断特别是病理学诊断、多学科讨论及分子肿瘤学委员会讨论、系统的疗效评估、科学的终点选择及术中术后的全过程管理。由于肝癌肝移植涉及系统免疫调节和免疫微环境重塑,其综合治疗的方案、方式都处于探讨阶段。新辅助治疗用于肝癌肝移植的术前降期或术前桥接在免疫治疗时代,是亟需探讨的重要问题。 In recent years, systemic therapy for hepatocellular carcinoma(HCC)has progressed rapidly. New immune-checkpoint inhibitors and molecular targeted drugs have been emerging,and new treatment concepts and treatment schemes continue to innovate. However,there are relatively few discussions on the choice of systemic treatment for HCC before surgery and its efficacy. Neoadjuvant systemic therapy for HCC can be divided into neoadjuvant systemic therapy for resectable HCC, conversion therapy for unresectable HCC and down-staging or bridging therapy before liver transplantation according to its purpose and subsequent surgical procedures. The neoadjuvant systemic therapy should be based on preoperative diagnosis,especially pathological diagnosis,multidisciplinary team(MDT) and molecular tumor board(MTB)discussion,efficacy evaluation,endpoint selection and whole process management during and after operation. Since liver transplantation for HCC involves systemic immune regulation and immune microenvironment remodeling,the comprehensive treatment options and methods are still in the stage of discussion. The use of neoadjuvant therapy for preoperative downstage or preoperative bridging of liver transplantation for liver cancer is an important issue that needs to be discussed in the age of immunotherapy.
机构地区 上海交通大学医学院附属仁济医院肝脏外科
出处 《中国实用外科杂志》 CAS CSCD 北大核心 2021年第3期326-331,共6页 Chinese Journal of Practical Surgery
基金 国家自然科学基金委青年项目(No.81902388) 上海市自然科学基金(No.18ZR1424200) 上海交通大学转化医学(医工交叉)课题(No.YG2017QN54)。
关键词 肝细胞癌 新辅助治疗 系统治疗 免疫治疗 hepatocellular carcinoma neoadjuvant therapy systemic therapy immune therapy
分类号 R6 [医药卫生—外科学]
