肝胆肿瘤新辅助治疗的模式及方案选择  

Mode and option of neoadjuvant therapy for hepatobiliary neoplasms

作　　者：肖治宇[1] 陈亚进[1] XIAO Zhi-yu;CHEN Ya-jin(Department of Hepatobiliary Surgery,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广东广州510120

出　　处：《中国实用外科杂志》2023年第3期276-280,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.81972263,No.82073045)。

摘　　要：随着针对不可切除肝胆肿瘤的转化治疗取得显著的成果,推进了肝胆肿瘤新辅助治疗的临床探索。初步研究表明:术前肝动脉灌注化疗、化疗、靶免等治疗能为可根治性切除同时合并高危复发因素的肝胆肿瘤带来显著生存获益,但仍缺乏高级别循证医学证据支持。对于病人的筛选需慎重,在治疗前需要经过多学科诊疗团队的全面评估。疾病控制率是选择治疗方案时重点考虑的因素,同时也要考虑新辅助治疗方案的不良反应导致的免疫毒性和手术退出风险。新辅助治疗的周期一般不超过3个月,达到目的后应尽早手术,以免错失手术时机。对于新辅助治疗后辅助治疗当前仍存在诸多争议,而探索肝胆肿瘤新辅助治疗方案的疗效预测因素是提高新辅助治疗成功率的关键。With the significant development of conversion therapy for unresectable hepatobiliary tumors,the clinical exploration of neoadjuvant therapy has also been promoted.Preliminary studies have shown that preoperative HAIC,chemotherapy,targeted immunotherapy and other treatments can bring considerable survival benefits to patients with resectable hepatobiliary tumors with high risk of recurrence.However,these treatments still lack high-level medical evidence.Target patients for neoadjuvant therapy should be carefully selected and thoroughly evaluated by a multidisciplinary team before treatment.The disease control rate is an important factor in the choice of treatment.The immunotoxicity and increased risk of surgical withdrawal,should also be considered. A cycle of neoadjuvant therapy ofno more than 3 months is appropriate. After reaching theexpected treatment, patients should undergo surgery as soon aspossible to avoid missing the appropriate timing of surgery.There are still many controversies about adjuvant therapy afterneoadjuvant therapy, and exploring the predictive factors ofthe efficacy of neoadjuvant therapy for hepatobiliary tumors isthe key to improving the success rate of neoadjuvant therapy.

关 键 词：肝胆恶性肿瘤 新辅助治疗 转化治疗 

分 类 号：R6[医药卫生—外科学]