不同肝病背景下晚期肝癌一线治疗方案的研究进展

陈 思敏1, 樊海 宁*2
1、青海大学
2、青海大学附属医院

摘要


肝癌是全球第六大常见癌症和第三大癌症相关死亡原因。而肝癌分为肝细胞癌和胆管细胞癌，大约 90%的
原发性肝癌是肝细胞癌（肝癌）。在乙肝疫苗普及前，我国乃至全球肝癌病因以病毒感染为主，尤其以乙肝病毒导致
肝硬化最终进展为肝癌三部曲居多。随着乙肝疫苗的普及以及百姓的生活水平、幸福指数的升高，酒精性肝硬化和
非酒精性脂肪性肝炎（NASH）等代谢性疾病导致的肝癌比例逐年升高。无论以何种病因导致的肝癌，肝癌患者就
诊时大多数已处于中晚期，癌细胞血管侵犯等病情严重，手术切除机率较少且难度较大。然而对于失去手术机会的
肝癌的患者预后差，进展快，总生存期短。因此，对于晚期肝癌患者而言，晚期一线治疗方案显得格外重要。本文
目的是对所有晚期肝癌一线治疗方案进行统计总结，对晚期肝癌患者治疗有一定的指导意义。
　　原发性肝癌的病理组织学类型主要包括肝细胞癌（肝癌）、肝内胆管癌和混合型肝细胞癌-胆管癌三种，其中肝
癌约占所有原发性肝癌的 75%~85%[1]。中国肝癌患者多具有乙型肝炎病毒感染、肝硬化背景，就诊时大多数为中晚
期，表现为肝内肿瘤负荷大、合并门静脉癌栓、肝功能差等[2]。此时对于此类患者而言，他们往往合并肝硬化、肝
腹水、低蛋白血症等多种并发症，已无法耐受手术。近年来，多学科综合治疗成为主流，使肝癌患者整体预后取得
了令人惊喜的进步。尤其免疫及靶向治疗药物在众多学者的研究及临床广泛应用，使得不可切除肝癌的一线治疗模
式发生了巨大的改变。特别是中晚期不可切除的肝癌，除了可采用多种药物联合使用，还可以采取系统治疗联合局
部治疗的方式来延长患者生存期，部分肿瘤经联合治疗后甚至可达到转化切除的目的[3]。因此，本文主要是对 2024
年多种晚期不可切除肝癌一线治疗方案做一个综述。

关键词


晚期肝癌；不可切除肝癌；靶向治疗；免疫治疗；介入治疗

全文:

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