临床外科杂志 ›› 2025, Vol. 33 ›› Issue (10): 1043-1047.doi: 10.3969/j.issn.1005-6483.20250942

• 专家笔谈 • 上一篇    下一篇

肝癌一期切除和转化切除的治疗决策进展

伍路 张向化 夏勇 沈锋   

  1. 200438 上海,海军军医大学第三附属医院肝外四科
  • 收稿日期:2025-09-24 出版日期:2025-11-11 发布日期:2025-11-11
  • 通讯作者: 沈锋,Email:shenfengehbh@sina.com
  • 基金资助:
    上海市卫生健康委员会卫生行业临床研究专项(202240272);上海市东方肝胆外科医院临床培育项目(2023LC003、2025LC03)

Update of clinical decision-making of upfront resection versus subsequent resection after neoadjuvant or conversion therapies among patients with hepatocellular carcinoma

WU Lu,ZHANG Xianghua,XIA Yong,SHEN Feng   

  1. Department of Hepatobiliary Surgery 4,the third hospital affiliated to Naval Medical University,China
  • Received:2025-09-24 Online:2025-11-11 Published:2025-11-11

摘要: 近年来,基于病人特征、生物标志物、检验组学和影像组学等结果的肝细胞癌(以下简称肝癌)的临床决策研究已经逐渐深入和精细化,与肝癌传统分期系统的治疗推荐形成有效互补和相互参照。随着肝癌筛查方案的推广,得以早期诊断并通过肝切除、移植或局部消融获得一期根治性治疗的肝癌比例处于上升趋势。多个队列研究和临床实践共识均认为,合并血管癌栓等危险因素的局部晚期肝癌获得一期根治的概率较低。中期肝癌有望获得一期根治但无瘤生存时间常不理想。近年来,随着药物和局部治疗的进展,若干队列研究报道局部晚期肝癌通过综合手段转化降期有较大比例可获得根治性治疗。中期肝癌术前新辅助或者转化降期后根治,有望提高无复发生存时间和总生存时间。

关键词: 肝肿瘤, 治疗选择, 临床决策, 预后预测

Abstract: In recent years, clinical decision-making system has been developed and refined by incorporating patient's characteristics,tumor markers,clinlabomics and radiomics and has served a complementary role with classic hepatocellular carcinoma clinical staging systems among therapeutic choices of hepatocellular carcinoma during past decade.With the promotion of liver cancer screening programs, increasing patients with very early or early-stage hepatocellular carcinoma may attain upfront cure by partial liver resection,transplantation or local ablation.Advanced hepatocellular carcinoma with vascular invasion has been identified as inappropriate candidates of upfront curative therapies among several cohorts and clinical practice consensus.A heterogenous proportion of intermediate stage hepatocellular carcinomas have been reported to attain upfront cure with usually short recurrence-free survival (RFS) among several prospective cohorts.An unneglectable of patients with advanced stage hepatocellular carcinomas has been reported to subsequent curative resection after downstaging by conversion therapies.Subsequent resection after neoadjuvant therapies have improved the RFS and overall survival of patients with intermediate hepatocellular carcinoma.

Key words: liver neoplasm, therapeutic option, clinical decision-making, prognostic prediction

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