病因和肝病背景对肝细胞癌综合治疗策略的影响  

Influence of etiology and liver disease background on comprehensivee treatment strategies for hepatocellular carcinoma

作　　者：杨朗 陈晓[1] 蔡建强[1] 赵宏[1] YANG Lang;CHEN Xiao;CAI Jian-qiang(Department of Hepatobiliary Surgery,Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]中国医学科学院肿瘤医院肝胆外科,北京100021

出　　处：《中国实用外科杂志》2024年第9期1005-1009,共5页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划基金项目(No.2023YFC3403800,No.2023YFC3403804);中国医学科学院医学与健康科技创新工程基金项目(No.2021-I2M-C&T-B-057)。

摘　　要：在全球范围内,肝癌的总体发病率仍在显著上升。肝癌的主要病因包括肝炎病毒感染、非酒精性脂肪性肝病(NAFLD)、酒精性肝病以及黄曲霉素暴露等,这些因素与不同类型的肝病背景密切相关。肝细胞癌(HCC)的治疗策略多样化,涵盖外科治疗、局部治疗和系统治疗,其中外科治疗在HCC病人的长期生存中占据重要地位。根据中国原发肝癌诊疗指南,推荐的治疗方式包括以切除为代表的外科治疗、以经导管动脉化疗栓塞(TACE)为代表的局部治疗,以及靶向药物和免疫治疗为代表的系统治疗。鉴于我国肝癌病人多存在乙型肝炎病毒(HBV)感染和肝硬化背景,且肿瘤多在晚期确诊,因此,治疗策略主要以手术为基础,通过综合治疗手段提高切除率,降低复发率,从而改善病人生存率。不同的病因和肝病背景对HCC的综合治疗策略产生重要影响。病毒性肝炎相关的HCC病人往往伴有肝硬化,在治疗过程中需要特别关注肝功能状态以及术后抗病毒治疗。NAFLD相关的HCC病人术后生存期较长,但手术风险较大,免疫治疗效果不如其他病因所致的HCC。此外,对于合并晚期肝硬化或门静脉瘤栓的HCC病人,局部治疗和系统治疗的策略需要根据具体的病因和病情进行个体化调整。未来,HCC的治疗将朝着更加精准化和个体化的方向发展,结合病因学和肝病背景,优化治疗策略,以期实现更好的治疗效果和远期生存率。The global incidence of liver cancer continues to rise significantly.The primary etiologies of liver cancer include hepatitis virus infections,non-alcoholic fatty liver disease(NAFLD),alcoholic liver disease,and aflatoxin exposure,all of which are closely associated with different types of liver disease backgrounds.The treatment strategies for hepatocellular carcinoma(HCC)are diverse,encompassing surgical treatment,local therapies,and systemic therapies,with surgical treatment playing a crucial role in the long-term survival of HCC patients.According to the Chinese guidelines for the diagnosis and treatment of primary liver cancer,the recommended treatment modalities include surgery,such as resection,local therapies represented by transarterial chemoembolization(TACE),and systemic treatments including targeted therapies and immunotherapies.Given that a significant proportion of HCC patients in China have a background of hepatitis B virus(HBV)infection and cirrhosis,with many tumors diagnosed at an advanced stage,treatment strategies primarily focus on surgery,supplemented by comprehensive treatment approaches to improve resection rates,reduce recurrence rates,and thereby enhance patient survival.Different etiologies and underlying liver disease significantly influence the comprehensive treatment strategies for HCC.Patients with HCC related to viral hepatitis often have concomitant cirrhosis,requiring careful management of liver function and postoperative antiviral therapy.Although patients with NAFLD-related HCC tend to have a longer postoperative survival period,they face higher surgical risks,and the efficacy of immunotherapy is generally less favorable compared to HCC of other etiologies.Additionally,for patients with HCC complicated by advanced cirrhosis or portal vein tumor thrombus,local and systemic treatment strategies need to be individualized based on the specific etiology and disease state.In the future,the treatment of HCC will evolve towards more precise and individualized approaches,integrating etio

关 键 词：肝细胞癌 综合治疗 病因学 非酒精性脂肪性肝病 病毒性肝炎 

分 类 号：R6[医药卫生—外科学]