切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (01) : 11 -15. doi: 10.3877/cma.j.issn.2095-3232.2024.01.003

所属专题: 述评 综述

专家论坛

靶向免疫治疗时代的肝癌肝切除术再思考
张占国()   
  1. 430030 武汉,华中科技大学同济医学院附属同济医院肝脏外科中心
  • 收稿日期:2023-10-04 出版日期:2024-02-10
  • 通信作者: 张占国
  • 基金资助:
    国家自然科学基金面上项目(82172976)

Rethink of hepatectomy for hepatocellular carcinoma in the era of targeted immunotherapy

Zhanguo Zhang()   

  1. Department of Hepatobiliary Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2023-10-04 Published:2024-02-10
  • Corresponding author: Zhanguo Zhang
引用本文:

张占国. 靶向免疫治疗时代的肝癌肝切除术再思考[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 11-15.

Zhanguo Zhang. Rethink of hepatectomy for hepatocellular carcinoma in the era of targeted immunotherapy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(01): 11-15.

外科手术一直以来都被认为是治愈肝细胞癌的最有效手段,即使经过近百年的发展,外科为患者带来的生存获益似乎并未进一步提高。近些年,靶向药物及免疫检查点抑制剂的广泛应用为肝癌的综合治疗和相关研究提供了新的发展方向。随着临床应用越来越多,靶免治疗在各阶段肝癌治疗中的优势也不断体现,这也让我们不得不重新思考原有的肝癌外科治疗理念是否仍然正确。在此我们深入讨论在靶免时代,肝癌肝切除术所面临的问题及可能的解决方案。

Surgery has been considered as the most effective treatment for hepatocellular carcinoma (HCC). In spite of almost 100-year development, the survival benefits brought by surgery for HCC patients have not been further improved. In recent years, widespread application of targeted drugs and immune checkpoint inhibitors have provided a novel development direction for comprehensive treatment and related research of HCC. With widespread clinical application, the advantages of targeted immune therapy in the treatment of HCC at all stages are constantly presented, which make surgeons rethink whether the original concept of surgery for HCC is still correct. In this article, the problems and potential solutions in hepatectomy for HCC in the era of targeted immunotherapy were in-depth discussed.

[1]
Zhu P, Liao W, Zhang WG, et al. A prospective study using propensity score matching to compare long-term survival outcomes after robotic-assisted, laparoscopic or open liver resection for patients with BCLC stage 0-A hepatocellular carcinoma[J]. Ann Surg, 2023, 277(1):e103-111.
[2]
Goh EL, Chidambaram S, Ma S. Laparoscopic vs open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a meta-analysis of the long-term survival outcomes[J]. Int J Surg,2018(50):35-42.
[3]
Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase Ⅲ randomised, double-blind, placebo-controlled trial[J]. Lancet Oncol, 2009, 10(1):25-34.
[4]
Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus Bevacizumab in unresectable hepatocellular carcinoma[J]. N Engl J Med, 2020, 382(20):1894-1905.
[5]
Finn RS, Ikeda M, Zhu AX, et al. PhaseⅠb study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma[J]. J Clin Oncol, 2020, 38(26):2960-2970.
[6]
Kelley RK, Sangro B, Harris W, et al. Safety, efficacy, and pharmacodynamics of tremelimumab plus durvalumab for patients with unresectable hepatocellular carcinoma: randomized expansion of a phase Ⅰ/Ⅱ study[J]. J Clin Oncol, 2021, 39(27):2991-3001.
[7]
Akce M, El-Rayes BF, Bekaii-Saab TS. Frontline therapy for advanced hepatocellular carcinoma: an update[J]. Therap Adv Gastroenterol, 2022(15):17562848221086126.
[8]
Zhang B, Zhang B, Zhang Z, et al. 42,573 cases of hepatectomy in China: a multicenter retrospective investigation[J]. Sci China Life Sci, 2018, 61(6):660-670.
[9]
Zhang XP, Gao YZ, Chen ZH, et al. An Eastern hepatobiliary surgery hospital/portal vein tumor thrombus scoring system as an aid to decision making on hepatectomy for hepatocellular carcinoma patients with portal vein tumor thrombus: a multicenter study[J]. Hepatology, 2019, 69(5):2076-2090.
[10]
Kamiyama T, Kakisaka T, Orimo T, et al. Hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus[J]. World J Hepatol, 2017, 9(36):1296-1304.
[11]
Finn RS, Merle P, Granito A, et al. Outcomes of sequential treatment with sorafenib followed by regorafenib for HCC: additional analyses from the phase Ⅲ RESORCE trial[J]. J Hepatol, 2018, 69(2):353-358.
[12]
中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识(2021版)[J]. 中国实用外科杂志, 2021, 41(6):618-632.
[13]
Wu CY, Chen YJ, Ho HJ, et al. Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection[J]. JAMA, 2012, 308(18):1906-1914.
[14]
Huang G, Lai EC, Lau WY, et al. Posthepatectomy HBV reactivation in hepatitis B-related hepatocellular carcinoma influences postoperative survival in patients with preoperative low HBV-DNA levels[J]. Ann Surg, 2013, 257(3):490-505.
[15]
Wang Z, Peng Y, Hu J, et al. Associating liver partition and portal vein ligation for staged hepatectomy for unresectable hepatitis B virus-related hepatocellular carcinoma: a single center study of 45 patients[J].Ann Surg, 2020, 271(3):534-541.
[16]
Chan A, Zhang WY, Chok K, et al. ALPPS versus portal vein embolization for hepatitis-related hepatocellular carcinoma: a changing paradigm in modulation of future liver remnant before major hepatectomy[J]. Ann Surg, 2021, 273(5):957-965.
[17]
中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022版)[J]. 中华消化外科杂志, 2022, 21(2):143-168.
[18]
Corcoran RB, Chabner BA. Application of cell-free DNA analysis to cancer treatment[J]. N Engl J Med, 2018, 379(18):1754-1765.
[19]
Wan JCM, Massie C, Garcia-Corbacho J, et al. Liquid biopsies come of age: towards implementation of circulating tumour DNA[J]. Nat Rev Cancer, 2017, 17(4):223-238.
[20]
Chin RI, Chen K, Usmani A, et al. Detection of solid tumor molecular residual disease (MRD) using circulating tumor DNA (ctDNA)[J]. Mol Diagn Ther, 2019, 23(3):311-331.
[21]
Cucchetti A, Zhong J, Berhane S, et al. The chances of hepatic resection curing hepatocellular carcinoma[J]. J Hepatol, 2020, 72(4): 711-717.
[22]
Xu XF, Xing H, Han J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China[J]. JAMA Surg, 2019, 154(3):209-217.
[23]
Colecchia A, Schiumerini R, Cucchetti A, et al. Prognostic factors for hepatocellular carcinoma recurrence[J]. World J Gastroenterol, 2014, 20(20):5935-5950.
[24]
Hasegawa K, Kokudo N, Imamura H, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma[J]. Ann Surg, 2005, 242(2):252-259.
[1] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[2] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[3] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[4] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[5] 林逸, 钟文龙, 李锴文, 何旺, 林天歆. 广东省医学会泌尿外科疑难病例多学科会诊(第15期)——转移性膀胱癌的综合治疗[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 648-652.
[6] 公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[7] 李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[8] 刘敏思, 李荣, 李媚. 基于GGT与Plt比值的模型在HBV相关肝细胞癌诊断中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 831-835.
[9] 焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[10] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[11] 袁雨涵, 杨盛力. 体液和组织蛋白质组学分析在肝癌早期分子诊断中的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 883-888.
[12] 吴警, 吐尔洪江·吐逊, 温浩. 肝切除术前肝功能评估新进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 889-893.
[13] 吴雪云, 胡小军, 范应方. 肝切除术中剩余肝再生能力的评估与预测[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 894-897.
[14] 陈伟杰, 何小东. 胆囊癌免疫靶向治疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 763-768.
[15] 王昌前, 林婷婷, 宁雨露, 王颖杰, 谭文勇. 光免疫治疗在肿瘤领域的临床应用新进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 575-583.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?