肝细胞癌合并门静脉癌栓多学科诊治创新体系建立及应用

门静脉癌栓是肝细胞癌发展到进展期最重要的标志之一,在初次就诊的肝细胞癌患者中门静脉癌栓的发生率高达44%~66.2%,在中晚期肝细胞癌患者中的这一比例更高（80%~90%）。肝细胞癌患者一旦发生门静脉癌栓,预后极差,自然生存时间仅为2.7~4个月。目前对于此类患者的治疗存在较大争议。欧美地区提倡索拉非尼是唯一的治疗方式;亚洲地区提倡多种治疗方式,包括手术治疗、经导管肝动脉化学栓塞治疗、放射治疗、系统化学治疗等。目前针对肝细胞癌合并门静脉癌栓的诊治尚未达成共识,本团队建立了肝细胞癌合并门静脉癌栓多学科诊治创新体系并对此展开了系统化的研究和应用。本文就肝细胞癌患者门静脉癌栓的发生机制、临床诊疗和多学科诊治创新体系的建立及应用展开讨论。

Establishment and application of a multidisciplinary team approach for hepatocellular carcinoma with portal vein tumor thrombus

Portal vein tumor thrombus (PVTT) is one of the most important clinical characteristics of advanced hepatocellular carcinoma (HCC). The incidence of PVTT has been reported to be 44%-66.2% in patients with HCC who were firstly diagnosed, and 80%-90% were patients with advanced HCC. Once PVTT occurs in patients with HCC, the prognosis is very poor, and the natural survival time is only 2.7-4 months. The current treatment strategy for HCC patients with PVTT remains controversial. Sorafenib is recommended as the only treatment option in Europe and America; and a variety of treatment methods, including surgical treatment, transcatheter arterial chemoembolization, radiotherapy, and systemic chemotherapy, were advocated in Asia. At present, there is no consensus on diagnosis and treatment of HCC with PVTT. Our team has established a multidisciplinary team approach for diagnosis and treatment of HCC with PVTT, and has carried out systematic research and application. This article reviews the molecular mechanism of PVTT in patients with HCC, clinical diagnosis and treatment of PVTT, and the establishment and application of a multidisciplinary team approach.