Hepatocellular carcinoma: Current management and future trends
Hepatocellular carcinoma: Current management and future trends
复制标题
DOI：
10.1053/j.gastro.2004.09.036
复制
发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Carr, BI
中科院分区：
文献类型：
--
作者：
Carr, BI
肝细胞癌（HCC）的特点是，它是在临床上确定的晚期阶段，通常与肝硬化。手术切除一直被认为是最佳的治疗方法，但只有一小部分患者符合手术条件，而且复发率很高。预防复发的方法包括术前化疗栓塞和术后新辅助治疗，这两种方法都没有被证明是有益的。肝移植在治疗局限期HCC方面已经取得成功，影响了肿瘤和潜在肝硬化的治愈。然而，只有少数HCC患者有资格接受移植。最近，化疗栓塞已被证明可以延长不符合移植或切除条件的选定患者的生存期。其他创新的，相对非侵入性的局部消融治疗已被引入，并已被证明是有效的，在减少肿瘤的大小，但在延长生存期。标准化疗在不符合切除条件的患者中耐受性差。多柔比星和顺铂都是常用的，但总体反应率较低，而且似乎都不能延长生存期。需要使用当前疗法进行前瞻性随机对照试验，以更好地确定这一重要肿瘤的最佳管理。然而，最需要的是新的治疗药物，对HCC有效，是无细胞毒性的，并耐受的典型患者与潜在的肝硬化。新出现的药物包括Y-90微球、抗血管生成剂、生长因子及其受体抑制剂和维生素K。
The hallmarks of hepatocellular carcinoma (HCC) are that it is identified clinically at an advanced stage and usually together with cirrhosis. Surgical resection has been considered the optimal treatment approach, but only a small proportion of patients qualify for surgery, and there is a high rate of recurrence. Approaches to prevent recurrence have included chemoembolization before and neoadjuvant therapy after surgery, neither of which has proven to be beneficial. Liver transplantation has been successful in treating limited-stage HCC, affecting cure of both the tumor and underlying cirrhosis. However, only a minority of patients with HCC qualify for transplantation. Recently, chemoembolization has been shown to prolong survival in selected patients who do not qualify for transplantation or resection. Other innovative, relatively noninvasive local ablative therapies have been introduced and have been shown to be effective in reducing tumor size but not in prolonging survival. Standard chemotherapy is poorly tolerated in patients who do not qualify for resection. Both doxorubicin and cisplatin are frequently used, but overall response rates are low, and neither seems to prolong survival. Prospective, randomized controlled trials using current therapies are needed to better define optimal management of this important tumor. Most needed, however, are new therapeutic agents that are effective against HCC, are noncytotoxic, and are tolerated by the typical patient with underlying cirrhosis. Newly emerging agents with promise include Y-90 microspheres, antiangiogenesis agents, inhibitors of growth factors and their receptors, and K vitamins.