肝细胞癌：外科治疗和进展的治疗

StephenW

Cancer Treat Res. 2016;168:165-83.
Hepatocellular Carcinoma: Surgical Management and Evolving Therapies.Kantor O, Baker MS.
AbstractHCC is the second leading cause of cancer death worldwide. The majority of cases arise within the background of liver cirrhosis and are most commonly related to chronic hepatitis B and C viral infection. Surgical resection, liver transplantation, and tumour ablation are potentially curative modalities in cases of localized, non-metastatic, hepatocellular carcinoma. Systemic sorafenib has been shown to be marginally effective in slow disease progression in patients whose cirrhosis is so severe that they are not candidates for liver directed therapy and in those with metastatic disease. Several large prospective and retrospective studies have demonstrated transplantation to provide better long term outcomes than resection in patients with small volume carcinoma. Other small retrospective series have demonstrated similar outcomes for patients with well matched tumour characteristics and compensated cirrhosis. There is not even level one evidence to guide the choice of modality to be used in individual cases and treatment algorithms vary widely among high volume centres. Newer and emerging techniques and approaches such as laparoscopic liver resection and living donor transplantation continue to evolve and impact choice of treatment in absence of well-controlled comparative trials. For locally advanced disease and in patients with significant cirrhosis, interventional technologies such as transarterial chemoembolization or transarterial radioembolization can provide disease control or result in tumour regression and hypertrophy in the future liver remnant and may allow interval resection or down-staging to liver transplantation. Improving transarterial, surgical, and transplant techniques continue to expand the surgical and interventional options for managing localized HCC and are driving a shift towards aggressive multimodality therapy in patients with localized hepatoma.


PMID:29206369

StephenW

癌症治疗研究。 2016; 168：165-83。
肝细胞癌：外科治疗和进展的治疗。
Kantor O，Baker MS。
抽象

HCC是全球癌症死亡的第二大原因。大多数病例发生在肝硬化的背景下，最常见的是慢性乙肝和丙肝病毒感染。手术切除，肝移植和肿瘤消融在局部非转移性肝细胞癌的病例中是潜在的治疗方式。已经显示，系统性索拉非尼在肝硬化严重以至于不适用于肝定向治疗和转移性疾病的患者中对疾病进展缓慢有效。几项大型的前瞻性和回顾性研究已经证明移植能够提供比小体积肿瘤患者更好的远期疗效。其他小规模的回顾性系列研究已经证实，具有良好匹配的肿瘤特征和代偿性肝硬化的患者具有相似的结果。甚至没有一个证据来指导在个案中使用的方式的选择，并且在高容量中心之间治疗算法差异很大。诸如腹腔镜肝切除术和活体供体移植之类的新兴技术和方法继续发展，并且在没有良好对照试验的情况下影响治疗的选择。对于局部晚期疾病和显着的肝硬化患者，介入技术如经动脉化疗栓塞或经动脉放射栓塞可以提供疾病控制或导致未来肝残留的肿瘤消退和肥大，并且可能允许间隔切除或肝移植的降级。改善动脉途径，手术和移植技术继续扩大了手术和介入治疗局限性HCC的选择，并推动了对局限性肝细胞瘤患者积极的多模式治疗的转变。

结论：
    29206369