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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 290 -298. doi: 10.3877/cma.j.issn.2095-3232.2026.03.002

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进展期肝癌治疗困境与探索：综述与展望
叶林森, 杨扬†()   
  1. 510630　广州，中山大学附属第三医院肝脏外科暨肝移植中心
  • 收稿日期:2025-11-25 出版日期:2026-06-10
  • 通信作者: 杨扬
  • 基金资助:
    国家重点研发计划基金(2024YFA1107200); 国家自然科学基金联合基金项目-重点支持项目(U24A20655); 广州市科技计划项目(2024A03J0273); 中山大学高校基本科研业务费(2023KYPT03); 中山大学附属第三医院“五个五”工程项目(2023WW107); 广州地区临床高新、重大、特色技术项目建设经费(140000020150)

Challenges and explorations of advanced liver cancer treatment: review and prospect

Linsen Ye, Yang Yang†()   

  1. Department of Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2025-11-25 Published:2026-06-10
  • Corresponding author: Yang Yang
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引用本文：

叶林森, 杨扬. 进展期肝癌治疗困境与探索：综述与展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 290-298.

Linsen Ye, Yang Yang. Challenges and explorations of advanced liver cancer treatment: review and prospect[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(03): 290-298.

进展期肝癌因其高度异质性、肝功能储备受限以及治疗窗口期窄，目前仍是临床治疗的重大挑战。本文系统回顾了进展期肝癌治疗面临的关键问题，包括疾病负担沉重、联合治疗的毒性累积以及肝功能保护与抗肿瘤疗效的平衡困境。在此基础上，本文重点阐述了三大优化策略：（1）治疗模式的优化。通过探索局部与系统治疗的协同增效机制和策略，发现潜在临床方案以实现肿瘤增效。（2）肿瘤治疗的器官功能保护。通过剂量优化和疗程调整在保证疗效的同时最大限度减少肝脏和全身毒性，从而提升长期生存。（3）肿瘤治疗效果的精准预测。通过生物标志物、分子分型和人工智能实现个体化治疗。建立肝癌疾病中心框架下的多学科诊疗团队为这些策略的临床转化提供了组织保障。未来需要进一步深化机制研究、优化治疗策略并推广成功经验，最终实现进展期肝癌患者生存期延长和生活质量改善的双重目标。

关键词: 进展期肝癌, 癌，肝细胞, 围手术期治疗, 靶向治疗, 免疫治疗, 多学科诊疗

Treatment of advanced liver cancer is still a major challenge in clinical settings because of its high heterogeneity, limited liver function reserve and narrow therapeutic window. In this article, the key challenges in the treatment of advanced liver cancer, including heavy disease burden, toxic accumulation of combined therapy and the balance dilemma between liver function protection and anti-tumor efficacy, were systematically reviewed. In this study, three optimization strategies were mainly illustrated: (1) Joint optimization of treatment modes. Synergistic sensitization mechanism and strategy of local and systemic therapy were investigated to explore the potential to enhance clinical efficacy for advanced liver cancer. (2) Functional protection of tumor treatment. Through dose optimization and course adjustment, the liver and systemic toxicities are minimized while ensuring clinical efficacy, thereby prolonging long-term survival. (3) Precise prediction of tumor treatment. Individualized therapy is achieved through biomarkers, molecular typing and artificial intelligence. The establishment of MDT under the framework of liver cancer center provides organizational guarantee for clinical translation of these strategies. In the future, it is necessary to further deepen the research of mechanism, optimize treatment strategies and spread successful experiences, eventually achieving the dual goals of prolonging survival time and improving the quality of life of patients with advanced liver cancer.

Key words: Advanced liver cancer, Carcinoma,hepatocellular, Perioperative therapy, Targeted therapy, Immunotherapy, Multidisciplinary team(MDT)
图1 中山大学附属第三医院中晚期肝癌MDT治疗流程图 注：ECOG-PS为东部肿瘤协作组-体能状态，T+A方案为阿替利珠单抗联合贝伐珠单抗的免疫靶向联合治疗方案，HAIC为经导管肝动脉灌注化疗，SBRT为体部立体定向放射治疗，EBRT为外放射治疗
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