肝癌的转化治疗策略

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...     

原发性肝癌转化治疗及其维持治疗策略

肝癌首选治疗方法为手术治疗,也是惟一能使病人获得长期生存甚至治愈的方法.但我国绝大多数肝癌病人在确诊时已处于中晚期,失去了手术机会.转化治疗是将不可切除的晚期肝癌或者潜在可切除转化为可根治性切除,故成为晚期肝癌治疗研究的热点.转化治疗的常用方法如下:(1)局部治疗,如肝动脉栓塞化疗(TACE)、经肝动脉放疗栓塞(TAR...     

肝癌转化治疗后手术相关问题

<正>原发性肝癌是全球排名第六的常见恶性肿瘤，是我国排名第四常见恶性肿瘤及第二肿瘤致死病因，其中肝细胞癌(以下简称肝癌)占75%～85%、胆管细胞癌占10%～15%^[1]。外科手术治疗可为肝癌患者提供治愈的机会，但我国大部分患者初诊时已处于中晚期，失去了手术机会。近年来，随着晚期肝癌的治疗进展，部分初始不可切除肝癌患者可通过转化治疗进而获得手术的机会，达到与一期切除相似的临床效果。本文查阅和总结了肝癌转化治疗后手术切除相关文献，及存在的问题和面临的挑战。     

不可切除中晚期肝癌的转化治疗后肝切除术

多数肝癌起病隐匿,早期症状不明显,就诊时往往已属中晚期,预后不佳.转化治疗可使不可切除晚期肝癌病人获得手术治疗机会,并达到R0切除.在转化治疗后,对病人肿瘤、肝脏及其他器官细致全面的评估,将为安全肝切除的术前决策提供依据.转化治疗期间建议采用多学科综合治疗协作组模式定期评估转化治疗效果,并及时制定手术切除方案.     

肝癌转化治疗相关技术方法及评价

由于肝癌发病早期无明显症状,大部分肝癌病人确诊时已属中晚期,失去根治性手术切除的机会.转化治疗有望将部分初始不可切除肝癌转化为可切除或接受更为有效的局部治疗手段,为病人争取根治性治疗机会、进一步延长生存期.对于病灶局限肝内的中晚期病人,肝动脉栓塞化疗(TACE)及肝动脉灌注化疗(HAIC)治疗可以缩小肿瘤负荷,或通过门...     

序贯经肝动脉化疗栓塞和门静脉栓塞联合系统治疗转化肝细胞癌合并肝中静脉癌栓手术切除1例报道

<正>目前国际上对中国肝癌分期(China liver cancer staging,CNLC)Ⅲa期及以上的中晚期肝细胞癌(简称肝癌)的手术治疗存在争议。欧美国家指南^[1]认为，手术切除难以达到根治目的，建议采用系统治疗等非手术治疗；而国内《原发性肝癌诊疗指南(2022年版)》^[2]认为，若满足技术可切除和肿瘤学获益的条件，可进行以手术切除为目的的综合转化治疗。笔者通过分享1例肝癌合并肝中静脉癌栓经转化治疗后成功根治性切除且获得良好远期疗效病例的体会，以探讨中晚期肝癌转化切除的治疗策略。     

重视原发性肝癌的综合治疗

手术切除虽是目前治疗肝癌的首选疗法,但就肝癌总体而言,手术切除率较低、术后复发率较高。因此,在21世纪综合治疗在肝癌治疗中仍占重要地位。过去,肝癌综合治疗主要针对不能切除的中晚期肝癌。近年,随着局部治疗和生物治疗进展,肝癌综合治疗概念有所更新,一是对可切除癌的术前、术中、术后综合治疗,以提高切除率、降低术后复发率;二是对不能切除的大肝癌,经综合治疗使瘤体缩小获二期切除;三是对不能耐受手术切除的肝癌,以局部治疗为主的综合治疗可望延长患者生命,甚至达治愈目的。20世纪肝切除技术有长足进步,手术禁区被一一突破。近年国内…     

关于肝癌消融治疗学科建设的若干思考

<正>中国肝癌患者就诊时肿瘤多较大、已为中晚期、多合并肝硬化、肝功能差[1],传统的手术切除治疗复发率较高。对于临床大量不宜手术切除的肝癌及复发癌患者,行局部消融治疗可有效凝固灭活肿瘤,因对肝脏创伤小、易于操作、疗效显著等优点,使肝癌的局部治疗取得了突破性进展[2-3],但临床上不少病例选择经皮微创消融治疗同样难度大,且技术要求高,规范化消融治疗的应用推广及复发问题仍较严重[4-5]。     

靶向联合免疫时代肝细胞癌转化治疗策略

肝细胞癌（以下简称肝癌）发病隐匿,多数患者就诊时已达中晚期,错失根治性治疗时机,导致较差的预后结局。转化治疗为不可切除肝癌创造可切除机会,是改善患者预后的重要手段。随着新型靶向药物、抗血管药物、免疫药物及多维治疗方案在肝癌治疗中带来更高的客观缓解率、更长的缓解持续时间,转化治疗成为肝癌临床研究的热点。靶向联合免疫治疗时...     

肝动脉灌注化疗在肝癌转化治疗中的作用

根治性切除是肝癌病人得以长期生存的主要治疗手段,然而我国肝癌诊断时大部分为中晚期,可行根治性切除者＜30％.众多学者尝试利用多种方式对初始不可切除肝癌进行转化治疗,力争缩小肿瘤或使肝癌降期,以创造更多手术切除机会.近年来,奥沙利铂/亚叶酸钙/5-氟尿嘧啶(FOLFOX)方案肝动脉灌注化疗在不可切除肝癌病人中呈现出明显优...     

肝动脉灌注化疗在肝癌转化治疗中的研究进展

原发性肝癌是目前我国第4位常见恶性肿瘤及第2位肿瘤致死病因,严重威胁我国人民的生命和健康。原发性肝癌中>90%病人是肝细胞癌(以下简称肝癌),其中66%的病人初诊时已处于中晚期,失去手术机会。因此,中晚期肝癌的防治及转化治疗尤为重要。肝动脉灌注化疗(HAIC)是中晚期肝癌的重要治疗手段,以其为核心的转化治疗展现出较好的肿瘤反应率及手术转化率。笔者深入分析国内外HAIC相关研究进展,系统阐述其发展历史及以HAIC为核心的转化治疗。     

降阶治疗在肝细胞肝癌治疗中的进展

目的 总结肝癌降阶治疗在肝癌治疗中的进展与地位。方法 通过检索MEDLINE 和PubMed数据库相关文献并对其进行分析与综述。结果 晚期肝癌临床预后差,降阶治疗后肝切除或肝移植术能显著改善患者的预后,但是不同的降阶治疗方法,不同的入组标准,使患者的临床疗效参差不齐。结论 根据不同的病情,选用合理的降阶治疗方法,可以提高患者的远期预后。     

Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition)

Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma (HCC) have resulted in improved response rates. This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection, a ‘conversion therapy’ strategy. However, conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed. Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice. Evidence review: Many research centers in China have accumulated significant experience implementing HCC conversion therapy. Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC; however, there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields. In order to summarize and learn from past experience and review current challenges, the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma (2021 Edition) was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice. Sixteen consensus statements on the implementation of conversion therapy for HCC were developed. The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.     

通过转化治疗提高结直肠癌肝转移手术切除率的新进展

目的了解通过转化治疗提高结直肠癌肝转移手术切除率的外科治疗新进展,评估预后评估模型在肝内转移灶切除术后的应用价值,进一步指导患者术后的综合治疗,从而控制疾病快速进展,改善患者的生存质量。方法收集国内外有关结直肠癌肝转移外科治疗新进展的文献,就结直肠癌肝转移的手术切除指征、预后评估模型以及如何通过转化治疗提高其手术切除率的新进展进行综述。结果通过积极的转化治疗,能够使部分结直肠癌肝转移患者接受手术切除肝内转移灶。对于自始至终均无法接受手术切除肝内转移灶的患者,术前化疗、分子靶向治疗药物、多种介入治疗等转化治疗方案均不失为安全、有效的治疗方法,其对患者的生活质量的提高、生存时间的延长有一定的效果。结论我们应该加强对结直肠癌肝转移转化治疗的重视,积极推动预后评估模型在肝内转移灶切除术后的应用。     

原发性肝癌综合治疗的进展和热点

原发性肝癌（本文特指肝细胞癌,以下简称肝癌）的治疗原则是以手术为主的综合治疗。围绕提高根治性手术切除率和降低术后复发率等难题,肝癌的转化治疗、新辅助治疗和术后辅助治疗应运而生,极大地丰富了综合治疗的内涵,也成为研究热点。肝癌侵袭转移性强且常合并肝硬化等,综合治疗必不可少,但因手术适应证仍存在争议、个体间异质性大等原因,...     

不可切除和中晚期肝癌的转化切除

近年来,肝癌的药物治疗取得显著进展,成为中晚期肝癌病人延长生存的重要手段.其中仑伐替尼联合程序性死亡因子1(PD-1)抗体的临床探索在中国非常普遍.部分不可切除或中晚期肝癌病人在接受仑伐替尼联合PD-1抗体治疗的过程中出现肿瘤缩小,从不可切除肝癌转变为可切除肝癌.此文从中国肝癌的现状、不可切除肝癌的转化治疗历史和近年来...     

Bridging Locoregional Therapy for Hepatocellular Carcinoma Prior to Liver Transplantation

Introduction  The impact of locoregional therapy prior to liver transplantation for hepatocellular carcinoma utilizing either transcatheter arterial chemoembolization (TACE), yttrium-90 (⁹⁰Y), radiofrequency ablation (RFA), or resection prior to orthotopic liver transplantation (OLT) is largely unknown. We sought to examine locoregional therapies and their effect on survival compared with transplantation alone. Methods  A retrospective review of a prospectively collected database. Results  123 patients were included. Patients were analyzed in two groups. Group I consisted of 50 patients that received therapy (20 TACE; 16 ⁹⁰Y; 13 RFA, 3 resections). Group II consisted of 73 patients transplanted without therapy. Median list time was 28 days (range 2–260 days ) in group I, and 24 days (range 1–380 days) in group II. Median time from therapy to OLT was 3.8 months (range 9 days to 68 months). Twelve patients (24%) were successfully downstaged (8 TACE, 2 ⁹⁰Y, 2 RFA/resection). Overall 1-, 3-, and 5-year survival were 81%, 74%, and 74%, respectively. Survival was not statistically significantly different between the two groups (P = 0.53). The 12 patients downstaged did not have a significant difference in survival as compared with the patients who received therapy but did not respond or the patients who were transplanted without therapy (P = 0.76). Conclusion  Our report addresses locoregional therapy for hepatocellular carcinoma as a bridge to transplant. There was no statistical difference in overall survival between patients treated and those not treated prior to transplant. We provide further evidence that locoregional therapy is a safe tool for patients on the transplant list, does not impact survival, and can downstage selected patients to allow life-saving liver transplantation.     

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??Treatment options for hepatocellular carcinoma: surgical resection, locoregional ablation, interventional therapy or liver transplantation? DOU Ke-feng, LI Xiao. Department of Hepato-biliary and Pancreato-splenic Surgery, Xijing Hospital,the Fourth Military Medical University, Xi’an 710032, China
Corresponding author: DOU Ke-feng,E-mail: gdwkgwx@fmmu.edu.cn
Abstract Nowadays, the treatment of hepatocellular carcinoma (HCC) mainly includes surgical resection, locoregional ablation, interventional therapy and liver transplantation. The indications of the four methods overlap partly, and there are some controversial viewpoints about the order of the methods’ application. It’s still a considerable challenge for surgeons to optimize personalized multimodality treatments for HCC.     

Immunotherapy for esophageal carcinoma

Recent progress in gene technology has clarified the existence of some cancer-rejection genes and peptides such as MAGE, MART, etc. Many clinical trials with cancer vaccines have been performed. Since the clinical efficacy of HLA class I-restricted peptide vaccines is still poor, many researchers are mainly administering dendritic cell therapies. However, there have been few clinicals trials of cancer-specific immunotherapy for esophageal carcinomas. We have performed cancer vaccine therapy with SART-1 peptide and locoregional adoptive immunotherapy with activated autologous lymphocytes for patients with advanced esophageal carcinoma in a phase I and a phase I/II trial, respectively. The clinical responses were poor in the vaccine trial because of the rapid growth of esophageal cancers and the requirement for more than 2 months to activate and increase killer T cells after in vivo vaccination, while locoregional adoptive immunotherapy was effective for the treatment of esophageal cancers even in advanced stages with organ metastases. Based on these results, we think that a combination immunotherapy with adoptive immunotherapy and vaccine therapy is needed for the treatment of advanced esophageal carcinomas.