中国实用外科杂志

中国实用外科杂志

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原发性肝癌新辅助治疗的共识与争议

朱小东1，周    俭1，2   

  1. 1复旦大学附属中山医院肝癌研究所肝肿瘤外科，上海200032；2上海市徐汇区中心医院，上海200030
  • 出版日期:2023-03-01

  • Online:2023-03-01

摘要： 术后复发是影响肝癌手术切除疗效提高的主要障碍，新辅助治疗是提高手术疗效的一种治疗模式。近年来，随着系统抗肿瘤治疗的进步，肝癌新辅助治疗领域的探索日渐活跃。新辅助治疗具有降低肿瘤负荷、提前消灭肝内播散的微转移灶、及早测试药物治疗敏感度等优势，但同时存在治疗后肿瘤进展或毒副反应致病人失去手术切除机会的风险。目前肝癌领域新辅助治疗的探索还停留在单臂探索性研究阶段，其中免疫检查点抑制剂单独使用或其与分子靶向药物的联合是目前新辅助治疗主要探索的方案。今后需要协作开展多中心的大型随机对照研究，从而阐明新辅助治疗领域的诸多关键问题，包括新辅助治疗相比直接手术或手术续贯辅助治疗是否可以让病人额外获益，探索通过生物标记物筛选合适的病人接受新辅助治疗以及使用病理学缓解作为长期疗效的替代终点等。解决这些问题，更需要多学科的协作，以高质量完成临床研究，帮助提高手术切除的疗效。

关键词: 肝细胞癌, 新辅助治疗, 手术, 免疫治疗, 分子靶向治疗

Abstract: Consensus and controversies of neoadjuvant therapy for primary liver cancer        ZHU Xiao-dong*, ZHOU Jian. *Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: ZHOU Jian, E-mail: zhou.jian@zs-hospital.sh.cn
Abstract    Postoperative recurrence is a major obstacle to improving surgical resection efficacy for hepatocellular carcinoma(HCC). Neoadjuvant therapy is a treatment pattern to improve the curative effects of surgery. In recent years, the exploration of neoadjuvant therapy for HCC has become increasingly active with the advancement of systemic anti-tumor therapy. Neoadjuvant therapy has the advantages of reducing tumor load, early eradication of intrahepatic disseminated micrometastases, and early evaluating drug sensitivity. Still, there is a risk of tumor progression or toxicity after treatment that may lead patients to lose the opportunity for surgical resection. The current exploration of neoadjuvant therapy in the field of HCC is still at the stage of single-arm exploratory studies. Immune checkpoint inhibitors alone or their combination with molecularly targeted agents are the main options currently being explored for neoadjuvant therapy. Collaborative randomized controlled studies are needed to elucidate many critical issues in the field of neoadjuvant therapy, including whether neoadjuvant therapy can provide additional benefit to patients compared to up-front surgery or surgical resection followed by adjuvant therapy, exploring biomarkers to screen appropriate patients for neoadjuvant therapy and using pathological response as a surrogate endpoint for long-term efficacy. Addressing these issues requires even more multidisciplinary collaboration to conduct multicenter high-quality clinical studies to improve the long-term effects of surgical resection.

Key words: hepatocellular carcinoma, neoadjuvant therapy, surgery, immunotherapy, molecular targeted therapy