提高进展期（巴塞罗那分期C期）肝细胞癌疗效的有效途径  

Effective ways to improve the prognosis of advanced stage （BCLC stage C） hepatocellular carcinoma

作　　者：程树群[1] 卫旭彪[1] 吴孟超[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院,上海200433

出　　处：《中华外科杂志》2015年第5期324-327,共4页Chinese Journal of Surgery

摘　　要：相对于早中期肝癌,进展期肝癌（国际巴塞罗那分期C期）指首诊时即发现有门静脉癌栓形成或伴有淋巴结转移和肝外转移等表现的肝癌.进展期肝癌的治疗手段有限,预后极差.欧美指南对这一期肝癌的治疗手段仅限为口服甲苯磺酸索拉非尼,但临床实际疗效不理想.国内的治疗手段则包括外科切除、介入化疗、放疗及传统中医药等.最新研究结果显示,以门静脉癌栓的“程氏分型”为基础,采用术前放疗降期后切除癌栓、术后早期使用甲苯磺酸索拉非尼及重视术后抗病毒治疗等手段能够有效地提高肝癌合并门静脉癌栓患者的疗效.对于合并淋巴结转移或肝外转移的肝癌,使用改良的Folfox4系统化疗方案有望改善预后.多学科协作团队模式能够更加科学合理地诊治合并门静脉癌栓或淋巴结转移及肝外转移的肝癌患者,是未来发展的趋势,也是提高疗效的有效途径.Hepatocellular carcinoma（HCC） with portal vein tumor thrombus（PVTT） or lymphatic/ extrahepatic metastasis is classified as advanced stage （Stage C of Bacelona Clinic Liver Cancer Staging）.There is few effective therapy for the advanced stage HCC,leading to an extremly poor prognosis.For these patients,Sorafinib is recommended as the only therapy by European and American guidelines,which has limited clinic effect.In China,besides Sorafinib,various therapies have also been suggested,including surgery,trans-arterial chemoembolization （TACE）,radiotherapy,as well as traditional Chinese medicine.Recently,it is reported that several therapies may be effective in treating HCC with PVTT which is classified based on Cheng＇ s classification,including surgery after ＂down-stage＂ radiotherapy,early use of sorafinib postoperatively,as well as postoperative antivirus treatment.The modified Folfox4 chemotherapy,is also a potential effective way to improve the prognosis of advanced stage HCC with lymphatic/extrahepatic metastasis.Mutiple disciplinary team which could faciliate the process of diagnosis and treatment of advanced stage HCC,is expected to favor the prognosis of these patients.

关 键 词：肝肿瘤 预后 术前放疗 抗病毒治疗 分子靶向治疗 

分 类 号：R735.7[医药卫生—肿瘤]