摘要
肝细胞癌(hepatocellular carcinoma,HCC)是一种发病率高、预后差的恶性肿瘤,多数患者确诊时已处于中晚期,丧失了手术切除的机会。虽然经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)被广泛推荐用于中晚期HCC的治疗,其疗效也得到多项随机对照试验的证实,但常因肿瘤负荷大、合并脉管癌栓、存在动-静脉瘘或呈浸润性生长等高危因素而受到限制。近年来,肝动脉灌注化疗(hepatic arterial infusion chemotherapy,HAIC)治疗中晚期HCC的临床证据日益丰富,尤其在合并上述高危因素的情况下,可有效提高局部控制率并延长患者生存期。近期多项研究及临床实践表明,TACE与HAIC作为两种有效的经动脉介入治疗方式,其作用机制不同,将二者有机结合可实现技术互补,产生协同抗肿瘤效应,从而进一步提高高危中晚期HCC患者的疗效。为此,现结合相关文献及临床应用经验,探讨TACE联合HAIC治疗中晚期HCC的理论基础、技术要点、优势人群、临床证据等,以期为该方案的规范应用和推广提供参考。
Hepatocellular carcinoma(HCC)is a malignancy with high incidence and poor prognosis.Most patients with HCC are diagnosed at an intermediate-advanced stage,losing the opportunity for surgical resection.Although transcatheter arterial chemoembolization(TACE)is recommended for intermediate-advanced stage HCC,supported by evidence from multiple randomized controlled trials,its efficacy is often limited by high-risk factors such as large tumor burden,vascular tumor thrombosis,arteriovenous shunting,or infiltrative growth pattern.In recent years,accumulating evidence has established hepatic arterial infusion chemotherapy(HAIC)as an effective treatment for intermediate-advanced stage HCC,especially in patients with these high-risk features,as it can significantly enhance local tumor control and prolong survival.Recent studies and clinical practice have demonstrated that TACE and HAIC,as two effective intra-arterial therapies,possess distinct mechanisms of action.Their rational combination allows for technical complementarity,yielding a synergistic anti-tumor effect and further improving outcomes in high-risk patients with intermediate-advanced stage HCC.In this context,based on relevant literature and clinical experience,this article discusses the theoretical rationale,technical essentials,appropriate patient selection,and clinical evidence for combining TACE with HAIC in the treatment of HCC,aiming to provide references for its standardized application and wider clinical adoption.
作者
郑康炼
王晓东
ZHENG Kanglian;WANG Xiaodong(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Interventional Therapy,Peking University Cancer Hospital,Beijing 100142,P.R.China)
出处
《中国普外基础与临床杂志》
2025年第12期1505-1510,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
国家自然科学基金面上项目(项目编号:82172039)
北京市医院管理中心临床医学发展专项“扬帆”计划项目(项目编号:ZYLX202117)。
关键词
肝细胞癌
经导管动脉化疗栓塞
肝动脉灌注化疗
技术理念
临床实践
hepatocellular carcinoma
transcatheter arterial chemoembolization
hepatic arterial infusion chemotherapy
technical essential
clinical practice
