肝癌的综合治疗  

Comprehesive management of hepatocellular carcinoma

作　　者：范上达[1,3] 邱宗祥[1,2,3] 潘冬平[1,3] 

机构地区：[1]香港大学玛丽医院外科系 [2]香港大学玛丽医院内科系 [3]香港大学癌症研究中心

出　　处：《中华消化外科杂志》2011年第4期241-246,共6页Chinese Journal of Digestive Surgery

摘　　要：肝癌在全球肿瘤致死原因中高居第3位，每年导致25万～100万人死亡。中国是肝癌发病率较高的国家。其主要病因是HBV感染，HBV携带者中肝癌总体发病率为0．5％，随着年龄的增长，发病率有增高的趋势，70岁时其发病率可达1％[1]。Hepatocellular carcinoma （HCC） is nowadays one of the leading common causes of cancer death and mostly occurs in hepatitis B endemic areas. Typically, HCC patients presented late and only about 20% of the patients are amendable to surgical interventions. Surgical resection is the main curative treatment option. Nevertheless, the recurrence rate after potential curative liver resection is still very high. On the other hand, liver transplantation is the treatment of choice for early small HCC but its application is limited by the availability of liver grafts. Radiofrequeney ablation is more commonly used in cirrhotic patients with small tumours who are not surgical candidates. Nowadays, transarterial chemoembolisation, drugeluting bead transarterial chemoembolisation and radioembolisati- on are the mainstay of treatments for the patients with intermediate HCC. Other systemic approaches, such as hormonal thera- py, immunotherapy and chemotherapy have disappointing results. In particular, HCC is highly refractory to cytotoxic chemotherapy. This is no convincing evidence thus far that systemic chemotherapy improves overall survival in advanced HCC patients. Recently, encouraging results have been shown in using sorafenib in the treatment of advanced HCC patients. Similar to sorafenib, other anti-angiogenic multi-targeted tyrosine kinase inhibitors, such as pazopanib, brivanib and axitinib also show promising activity in various stages of clinical trials. There is an urgent need to identify biomarkers that may guide the rational use of sorafenib and other targeted agents in the era of personalised medicine. More importantly, the multidisciplinary model in managing HCC patients is the important key to the future success.

关 键 词：肝肿瘤 肝切除术 肝移植 肝动脉化学栓塞 分子靶向疗法 

分 类 号：R735.7[医药卫生—肿瘤]