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原发性肝癌转化治疗进展与思考OA

Advances and perspectives on conversion therapy for primary liver cancer

中文摘要英文摘要

原发性肝癌(本文特指肝细胞癌,以下简称肝癌)是我国发病率和病死率均较高的恶性肿瘤之一.由于多数患者初诊时已处于中晚期,或合并肝硬化导致肝功能储备不足,根治性手术机会有限.近年来,借鉴结直肠癌的治疗经验,转化治疗作为一种以根治性切除为目标的综合治疗策略,在肝癌领域受到广泛关注.该策略通过系统治疗、局部治疗或二者联合,使初始不可切除肝癌转变为具备根治性切除条件,从而改善患者的长期生存结局.随着靶向治疗、免疫治疗及局部治疗手段的快速发展,转化治疗已成为我国肝癌治疗领域的研究热点,并在临床实践中取得积极进展.然而,转化治疗在适用人群筛选、手术价值评估、手术时机把握及术后管理等方面仍存在诸多争议.本文结合近年来肿瘤学转化治疗的研究进展,围绕相关关键问题进行系统梳理与深入评述,旨在推动转化治疗理念的统一与临床实践的规范化,进一步提升中晚期肝癌的整体治疗水平.

Primary liver cancer,specifically referring to hepatocellular carcinoma(hereafter referred to as HCC)in this article,is one of the malignant tumors with relatively high incidence and mortality in China.Because most patients are diagnosed at an intermediate or advanced stage,or present with impaired hepatic reserve due to underlying liver cirrhosis,opportunities for curative surgical resection are limited.In recent years,drawing on therapeutic experience from colorectal cancer,conversion therapy has attracted considerable attention in the field of liver cancer as a comprehensive treatment strategy aimed at achieving radical resection.Through systemic therapy,locoregional treatment,or their combination,this approach seeks to convert initially unresectable HCC into tumors amenable to radical resection,thereby improving long-term survival outcomes.With the rapid development of targeted therapies,immunotherapy,and locoregional treatment modalities,conversion therapy has become a major research focus in liver cancer management in China and has achieved encouraging progress in clinical practice.Nevertheless,substantial controversies remain regarding patient selection,the value of surgery after conversion,optimal timing of resection,and postoperative management.In this article,recent advances in oncological conversion therapy are systematically reviewed and critically appraised,with the aim of promoting conceptual consensus and standardized clinical implementation of conversion therapy,ultimately improving the overall treatment outcomes of patients with intermediate to advanced hepatocellular carcinoma.

袁声贤;丁冬阳;周伟平

中国人民解放军海军军医大学第三附属医院 肝外三科,上海 200082中国人民解放军海军军医大学第三附属医院 肝外三科,上海 200082中国人民解放军海军军医大学第三附属医院 肝外三科,上海 200082

医药卫生

癌,肝细胞转化治疗新辅助疗法免疫疗法

Carcinoma,HepatocellularConversion TherapyNeoadjuvant TherapyImmunotherapy

《中国普通外科杂志》 2026 (1)

53-59,7

国家自然科学基金资助项目(82473341,82573583).

10.7659/j.issn.1005-6947.250551

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