摘要
肝脏是恶性肿瘤转移最常见的靶器官之一,转移率为11.1%;恶性肿瘤患者40%出现肝转移.转移性肝癌不仅在原发肿瘤来源、肿瘤基因和生物学行为等方面存在个体化差异,而且在肿瘤进展阶段、解剖学特点、机体功能、并发症等方面亦存在差异.针对转移肿瘤来源和途径不同,转移性肝癌治疗涉及原发肿瘤和肝转移肿瘤两个方面,如何合理选择手术、局部消融、化疗、分子靶向药物、内分泌、生物免疫、放射等治疗方法及治疗时机,是转移性肝癌治疗的关键.利用现代先进的影像学技术明确转移性肝癌肿瘤大小、数目、部位、血供等情况,为精确制定转移性肝癌个体化治疗方案提供客观依据.目前任何一种治疗转移性肝癌的方法均有其各自的适应证,对于不能手术根治切除的转移性肝癌,单一治疗方法难以达到治愈或控制肿瘤进展,需要两种或两种以上治疗方法有机地联合,达到协同增效的治疗效果.依据患者的具体情况,分析其个体特性,结合临床医生的临床经验和最佳证据,制定出符合循证医学原则的个体化治疗方案,才能使转移性肝癌患者最大程度获益,改善患者生存质量,延长生存期.
The liver is one of the most common target organs for metastasis of malignant tumors, with a metastasis rate of 11.1%. Approximately 40% of patients with malignant tumors will develop liver metastasis. Metastatic liver cancer not only exhibits individualized difference in the origin of primary tumor, tumor gene,and biological behavior, but also varies in the stage of progression, anatomic characteristics, organ function, and complications. In view of the different sources and pathways of metastatic tumors, the treatment of metastatic liver cancer involves two aspects： primary tumor and liver metastasis. How to choose surgery, local ablation, chemotherapy, molecular targeted drugs, endocrine therapy, biological and immune therapy, and radiotherapy as well as the treatment opportunity rationally is the key to the treatment of metastatic liver cancer. Advanced imaging techniques are used to determine the size, number, location, and blood supply of metastatic liver cancer, so as to provide an objective basis for making an accurate individualized treatment plan for metastatic liver cancer. At present, any single therapy for metastatic liver cancer has its own indications. If a metastatic liver tumor cannot be resected radically, the use of a single therapy is difficult to cure or control the progression of the tumor. In this case, it is necessary to combine two or more than two kinds of treatment methods to achieve the synergistic effect. According to the specific condition of patients with metastatic liver cancer, the individual characteristics of the patients should be analyzed by experienced clinicians to formulate an individualized treatment plan in accordance with the principles of evidence-based medicine, so as to make the patients benefit most from the plan, improve the quality of life, and prolong the survival time.
作者
秦建民
Jian-Min Qin(Department of General Surgery,the Third Hospital Affiliated to Naval Military Medical University,Shanghai 201805,China)
出处
《世界华人消化杂志》
CAS
2018年第29期1677-1687,共11页
World Chinese Journal of Digestology
关键词
转移性肝癌
个体化治疗
临床意义
Metastatic liver cancer
Individualized treatment
Clinical significance
