肝癌转化治疗策略选择和手术时机

doi:10.3877/cma.j.issn.2095-3232.2026.01.004

肝细胞癌（HCC）是全球范围内严重威胁人类健康的恶性肿瘤之一。尤其在中国，初诊时中晚期肝癌患者的比例超过70%，大部分患者失去手术机会。肝癌高发病率和死亡率使其治疗策略研究成为医学界重点。近年来，转化治疗成为无法手术切除患者的重要方法。通过靶向药物、免疫治疗及局部治疗，部分患者从不可切除转为可切除，改善预后。随着转化治疗理念的更新和扩展，科学、个体化选择治疗方案，以及准确掌握转化后手术时机和安全性，仍需进一步探讨和研究。

关键词: 癌，肝细胞, 转化治疗, 系统性治疗, 手术切除

Hepatocellular carcinoma (HCC) is one of the malignant tumors causing severe threats to human health worldwide. Especially in China, the proportion of patients with middle-advanced HCC upon initial diagnosis exceeds 70%, and most patients miss the opportunity of surgery. High incidence and mortality rates of HCC make the study of treatment strategy become the hot spot in medical community. In recent years, conversion therapy has become an important option for inoperable patients. Through targeted drugs, immunotherapy and topical treatment, partial patients benefit from unresectable to resectable conversion and obtain favorable prognosis. With the updates and expansion of the concept of conversion therapy, it is still necessary to further investigate and analyze the scientific and individualized selection of treatment regimen and accurately grasp the timing and safety of surgery after conversion therapy.

Key words: Carcinoma,hepatocellular, Conversion therapy, Systemic treatment, Surgical excision

[1]	Rumgay H, Arnold M, Ferlay J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040[J]. J Hepatol, 2022, 77(6): 1598-1606. DOI: 10.1016/j.jhep.2022.08.021.
[2]	中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(4): 407-449. DOI: 10.3877/cma.j.issn.2095-3232.2024.04.001.
[3]	Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study[J]. Gastroenterology, 2021, 160(1): 99-114. e3. DOI: 10.1053/j.gastro.2020.04.014.
[4]	Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition)[J]. Liver Cancer, 2020, 9(6): 682-720. DOI: 10.1159/000509424.
[5]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[6]	Villanueva A. Hepatocellular carcinoma[J]. N Engl J Med, 2019, 380(15): 1450-1462. DOI: 10.1056/nejmra1713263.
[7]	Forner A, Reig M, Bruix J. Hepatocellular carcinoma[J]. Lancet, 2018, 391(10127): 1301-1314. DOI: 10.1016/S0140-6736(18)30010-2.
[8]	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. DOI: 10.19538/j.cjps.issn1005-2208.2021.06.02.
[9]	中国抗癌协会肝癌专业委员会转化治疗协作组. 原发性肝癌转化及围手术期治疗中国专家共识(2024版)[J]. 中华消化外科杂志, 2024, 23(4): 492-513. DOI: 10.19538/j.cjps.issn1005-2208.2021.06.02.
[10]	中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 实用肝脏病杂志, 2023, 26(3): S18-S38. DOI: 10.3969/j.issn.1672-5069.2023.03.040.
[11]	Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg, 2012, 255(3): 405-414. DOI: 10.1097/SLA.0b013e31824856f5.
[12]	Dhurandhar V, Waugh R, Ahmed S, et al. An observational study to determine volume changes in the functional liver remnant following portal vein embolization[J]. JGH Open, 2021, 5(8): 941-946. DOI: 10.1002/jgh3.12614.
[13]	Aloia TA. Associating liver partition and portal vein ligation for staged hepatectomy: portal vein embolization should remain the gold standard[J]. JAMA Surg, 2015, 150(10): 927-928. DOI: 10.1001/jamasurg.2015.1646.
[14]	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. DOI: 10.1097/SLA.0000000000002942.
[15]	Luo XY, Wu KM, He XX. Advances in drug development for hepatocellular carcinoma: clinical trials and potential therapeutic targets[J]. J Exp Clin Cancer Res, 2021, 40(1): 172. DOI: 10.1186/s13046-021-01968-w.
[16]	Finn RS, Ikeda M, Zhu AX, et al. Phase ib study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma[J]. J Clin Oncol, 2020, 38(26): 2960-2970. DOI: 10.1200/jco.20.00808.
[17]	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. DOI: 10.1056/NEJMoa1915745.
[18]	Qin S, Chan SL, Gu S, et al. Camrelizumab plus rivoceranib versus sorafenib as first-line therapy for unresectable hepatocellular carcinoma (CARES-310): a randomised, open-label, international phase 3 study[J]. Lancet, 2023, 402(10408): 1133-1146. DOI: 10.1016/S0140-6736(23)00961-3.
[19]	Salem R. Hepatic arterial infusion chemotherapy for large hepatocellular carcinoma: ready for prime time?[J]. J Clin Oncol, 2022, 40(2): 118-119. DOI: 10.1200/JCO.21.02392.
[20]	Li QJ, He MK, Chen HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: a randomized phase Ⅲ trial[J]. J Clin Oncol, 2022, 40(2): 150-160. DOI: 10.1200/JCO.21.00608.
[21]	Greten TF, Mauda-Havakuk M, Heinrich B, et al. Combined locoregional-immunotherapy for liver cancer[J]. J Hepatol, 2019, 70(5): 999-1007. DOI: 10.1016/j.jhep.2019.01.027.
[22]	Yang F, Xu GL, Huang JT, et al. Transarterial chemoembolization combined with immune checkpoint inhibitors and tyrosine kinase inhibitors for unresectable hepatocellular carcinoma: efficacy and systemic immune response[J]. Front Immunol, 2022, 13: 847601. DOI: 10.3389/fimmu.2022.847601.
[23]	Ke Q, Xin F, Fang H, et al. The significance of transarterial chemo(embolization) combined with tyrosine kinase inhibitors and immune checkpoint inhibitors for unresectable hepatocellular carcinoma in the era of systemic therapy: a systematic review[J]. Front Immunol, 2022, 13: 913464. DOI: 10.3389/fimmu.2022.913464.
[24]	Cai M, Huang W, Huang J, et al. Transarterial chemoembolization combined with lenvatinib plus PD-1 inhibitor for advanced hepatocellular carcinoma: a retrospective cohort study[J]. Front Immunol, 2022, 13: 848387. DOI: 10.3389/fimmu.2022.848387.
[25]	Wu JY, Yin ZY, Bai YN, et al. Lenvatinib combined with anti-PD-1 antibodies plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a multicenter retrospective study[J]. J Hepatocell Carcinoma, 2021, 8: 1233-1240. DOI: 10.2147/JHC.S332420.
[26]	Wu JY, Wu JY, Li YN, et al. Lenvatinib combined with anti-PD-1 antibodies plus transcatheter arterial chemoembolization for neoadjuvant treatment of resectable hepatocellular carcinoma with high risk of recurrence: a multicenter retrospective study[J]. Front Oncol, 2022, 12: 985380. DOI: 10.3389/fonc.2022.985380.
[27]	Cao F, Yang Y, Si T, et al. The efficacy of TACE combined with lenvatinib plus sintilimab in unresectable hepatocellular carcinoma: a multicenter retrospective study[J]. Front Oncol, 2021, 11: 783480. DOI: 10.3389/fonc.2021.783480.
[28]	Zhu HD, Li HL, Huang MS, et al. Transarterial chemoembolization with PD-(L)₁ inhibitors plus molecular targeted therapies for hepatocellular carcinoma (CHANCE001)[J]. Signal Transduct Target Ther, 2023, 8(1): 58. DOI: 10.1038/s41392-022-01235-0.
[29]	Xin Y, Zhang X, Liu N, et al. Efficacy and safety of lenvatinib plus PD-1 inhibitor with or without transarterial chemoembolization in unresectable hepatocellular carcinoma[J]. Hepatol Int, 2023, 17(3): 753-764. DOI: 10.1007/s12072-023-10502-3.
[30]	Sun L, Hu Z, Xie W, et al. Sequential vs. concurrent systemic therapies in combination with FOLFOX-HAIC for locally advanced hepatocellular carcinoma: a single-center, real-world cohort study[J]. BMC Cancer, 2024, 24(1): 1168. DOI: 10.1186/s12885-024-12940-0.
[31]	Li B, Wang C, He W, et al. Watch-and-wait strategy vs. resection in patients with radiologic complete response after conversion therapy for initially unresectable hepatocellular carcinoma: a propensity score-matching comparative study[J]. Int J Surg, 2024, 110(5): 2545-2555. DOI: 10.1097/JS9.0000000000001155.
[32]	李雪瑞, 张雯雯, 胡丙洋, 等. 免疫联合靶向序贯外科手术方案治疗初始不可切除肝细胞癌的临床疗效评估[J]. 中华肝胆外科杂志, 2023, 29(1): 15-21. DOI: 10.3760/cma.j.cn113884-20221125-00441.
[33]	Zhu XD, Huang C, Shen YH, et al. Hepatectomy after conversion therapy using tyrosine kinase inhibitors plus anti-PD-1 antibody therapy for patients with unresectable hepatocellular carcinoma[J]. Ann Surg Oncol, 2023, 30(5): 2782-2790. DOI: 10.1245/s10434-022-12530-z.
[34]	Cao Y, Tang H, Hu B, et al. Comparison of survival benefit between salvage surgery after conversion therapy versus surgery alone for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis[J]. HPB, 2023, 25(7): 775-787. DOI: 10.1016/j.hpb.2023.03.004.
[35]	Bertacco A, Vitale A, Mescoli C, et al. Sorafenib treatment has the potential to downstage advanced hepatocellular carcinoma before liver resection[J]. Per Med, 2020, 17(2): 83-87. DOI: 10.2217/pme-2018-0114.
[36]	Li C, Wang MD, Lu L, et al. Preoperative transcatheter arterial chemoembolization for surgical resection of huge hepatocellular carcinoma (≥ 10 cm): a multicenter propensity matching analysis[J]. Hepatol Int, 2019, 13(6): 736-747. DOI: 10.1007/s12072-019-09981-0.

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Strategy selection and timing of conversion therapy for hepatocellular carcinoma

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Strategy selection and timing of conversion therapy for hepatocellular carcinoma