肝动脉化疗栓塞术联合治疗原发性肝癌的研究现状及进展
Research Status and Progress of Transcatheter Arterial Chemoembolization Combined with Transcatheter Arterial Chemoembolization in the Treatment of Primary Liver Cancer
摘要: 肝细胞癌作为比较常见的一种恶性肿瘤,其致死率非常高,目前大部分肝细胞癌患者到院就诊时已经处于中晚期,可进行手术治疗的病例非常少,预后效果不理想。目前肝动脉化疗栓塞术在肝细胞癌的临床中已经得到了广泛应用,且所获疗效也得到了认可。为进一步探讨分析加深对肝动脉化疗栓塞术的认识,本次研究就肝动脉化疗栓塞术联合治疗原发性肝癌的研究现状及进展进行综述,希望可为今后肝细胞癌患者治疗方案的明确提供可参考依据。
Abstract: Hepatocellular carcinoma (HCC) is a common malignant tumor, and its mortality rate is very high. At present, most patients with HCC are in the middle and late stages when they go to the hospital. There are very few cases of feasible surgical treatment, and the prognosis is not ideal. At present, transcatheter arterial chemoembolization has been widely used in the clinical treatment of hepatocellular carcinoma, and its efficacy has also been recognized. In order to further explore and deepen the understanding of transcatheter arterial chemoembolization, this study reviewed the research status and progress of transcatheter arterial chemoembolization in the treatment of primary liver cancer, hoping to provide a reference for the future treatment of patients with hepatocellular carcinoma.
文章引用:韦秋吉, 黄家龙, 黄云清, 区军杰. 肝动脉化疗栓塞术联合治疗原发性肝癌的研究现状及进展[J]. 临床医学进展, 2025, 15(1): 1558-1566. https://doi.org/10.12677/acm.2025.151208

参考文献

[1] 中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版) [J]. 协和医学杂志, 2024, 15(3): 532-559.
[2] Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A. and Jemal, A. (2018) Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 68, 394-424. [Google Scholar] [CrossRef] [PubMed]
[3] 王裕新, 潘凯枫, 李文庆. 2022全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2024, 10(3):1-16.
[4] 戴靖宜, 蒋敬庭. 肝细胞肝癌肿瘤标志物诊断的新进展[J]. 诊断学理论与实践, 2023, 22(5): 486-493.
[5] Yang, J.D., Hainaut, P., Gores, G.J., Amadou, A., Plymoth, A. and Roberts, L.R. (2019) A Global View of Hepatocellular Carcinoma: Trends, Risk, Prevention and Management. Nature Reviews Gastroenterology & Hepatology, 16, 589-604. [Google Scholar] [CrossRef] [PubMed]
[6] 路丽霞, 王荣琦. 原发性肝癌基层筛查与健康监测管理的研究进展[J]. 中国全科医学, 2023, 26(36): 4505-4509.
[7] Zhou, H. and Song, T. (2021) Conversion Therapy and Maintenance Therapy for Primary Hepatocellular Carcinoma. BioScience Trends, 15, 155-160. [Google Scholar] [CrossRef] [PubMed]
[8] 丁晓毅, 王征, 石洁, 等. 中国肝癌多学科综合治疗专家共识[J]. 临床肝胆病杂志, 2021, 37(2): 278-285.
[9] 赵荣策, 韦玮, 李少华, 等. 肝动脉灌注化疗在肝癌围手术期的应用及研究进展[J]. 中国肿瘤外科杂志, 2022, 14(2): 105-110.
[10] Zhang, W., Wu, L., Chen, L., Sun, T., Ren, Y., Sun, B., et al. (2022) The Efficacy of Drug-Eluting Bead or Conventional Transarterial Chemoembolization plus Apatinib for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. Scientific Reports, 12, Article No. 5725. [Google Scholar] [CrossRef] [PubMed]
[11] 张大闯, 马富权, 马富平, 等. 载药微球与传统C-TACE在治疗乏血供型原发性肝癌中的临床疗效对比[J]. 现代消化及介入诊疗, 2021, 26(6): 689-692.
[12] Han, T., Yang, X., Zhang, Y., Li, G., Liu, L., Chen, T., et al. (2019) The Clinical Safety and Efficacy of Conventional Transcatheter Arterial Chemoembolization and Drug-Eluting Beads-Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Meta-analysis. BioScience Trends, 13, 374-381. [Google Scholar] [CrossRef] [PubMed]
[13] Ayyub, J., Dabhi, K.N., Gohil, N.V., Tanveer, N., Hussein, S., Pingili, S., et al. (2023) Evaluation of the Safety and Efficacy of Conventional Transarterial Chemoembolization (cTACE) and Drug-Eluting Bead (DEB)-TACE in the Management of Unresectable Hepatocellular Carcinoma: A Systematic Review. Cureus, 15, e41943. [Google Scholar] [CrossRef] [PubMed]
[14] Chen, C., Liu, T., Shao, Y., Liu, K., Liang, P. and Lin, Z. (2021) Revisiting Hepatic Artery Infusion Chemotherapy in the Treatment of Advanced Hepatocellular Carcinoma. International Journal of Molecular Sciences, 22, Article 12880. [Google Scholar] [CrossRef] [PubMed]
[15] Guo, W., Gao, J., Zhuang, W., Wu, Z., Li, B. and Chen, S. (2019) Efficacy and Safety of Hepatic Arterial Infusion Chemotherapy Combined with Transarterial Embolization for Unresectable Hepatocellular Carcinoma: A Propensity Score‐Matching Cohort Study. JGH Open, 4, 477-483. [Google Scholar] [CrossRef] [PubMed]
[16] 杨俊, 印于, 张申, 等. HAIC序贯TAE治疗不可切除肝细胞癌的安全性和有效性[J]. 介入放射学杂志, 2023, 32(3): 229-232.
[17] Liu, B., Gao, S., Zhu, X., Guo, J., Kou, F., Liu, S., et al. (2021) Combination Therapy of Chemoembolization and Hepatic Arterial Infusion Chemotherapy in Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis Compared with Chemoembolization Alone: A Propensity Score‐Matched Analysis. BioMed Research International, 2021, Article ID: 6670367. [Google Scholar] [CrossRef] [PubMed]
[18] 夏银锋, 陈红, 涂兵. 经动脉化疗栓塞(TACE)联合经动脉灌注化疗(HAIC)对比单纯TACE治疗不可切除肝癌的疗效及安全性[J]. 临床医学进展, 2023, 13(5): 8156-8162.
[19] Huang, J., Huang, W., Zhan, M., Guo, Y., Liang, L., Cai, M., et al. (2021) Drug-Eluting Bead Transarterial Chemoembolization Combined with Folfox-Based Hepatic Arterial Infusion Chemotherapy for Large or Huge Hepatocellular Carcinoma. Journal of Hepatocellular Carcinoma, 8, 1445-1458. [Google Scholar] [CrossRef] [PubMed]
[20] Nakano, M.M., Yamamoto, A., Nishida, N., Hamuro, M., Hamamoto, S., Jogo, A., et al. (2019) Risk Factors for Local Recurrence of Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization with Drug-Eluting Beads (DEB-TACE). Japanese Journal of Radiology, 37, 543-548. [Google Scholar] [CrossRef] [PubMed]
[21] Zhang, X., Lin, X., Qiu, H. and Peng, Z. (2019) An Investigation of Efficacy, Safety, and Prognostic Factors of Drug‐eluting Beads‐Transarterial Chemoembolization Operation with Callispheres® Microspheres in Treating Chinese Hepatocellular Carcinoma Patients. Journal of Clinical Laboratory Analysis, 33, e22975. [Google Scholar] [CrossRef] [PubMed]
[22] Duan, R., Gong, F., Wang, Y., Huang, C., Wu, J., Hu, L., et al. (2023) Transarterial Chemoembolization (TACE) plus Tyrosine Kinase Inhibitors versus TACE in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. World Journal of Surgical Oncology, 21, Article No. 120. [Google Scholar] [CrossRef] [PubMed]
[23] Mou, L., Tian, X., Zhou, B., Zhan, Y., Chen, J., Lu, Y., et al. (2021) Improving Outcomes of Tyrosine Kinase Inhibitors in Hepatocellular Carcinoma: New Data and Ongoing Trials. Frontiers in Oncology, 11, Article 752725. [Google Scholar] [CrossRef] [PubMed]
[24] Ayati, A., Moghimi, S., Salarinejad, S., Safavi, M., Pouramiri, B. and Foroumadi, A. (2020) A Review on Progression of Epidermal Growth Factor Receptor (EGFR) Inhibitors as an Efficient Approach in Cancer Targeted Therapy. Bioorganic Chemistry, 99, Article ID: 103811. [Google Scholar] [CrossRef] [PubMed]
[25] Huang, L., Jiang, S. and Shi, Y. (2020) Tyrosine Kinase Inhibitors for Solid Tumors in the Past 20 Years (2001-2020). Journal of Hematology & Oncology, 13, Article No. 143. [Google Scholar] [CrossRef] [PubMed]
[26] Kudo, M., Ueshima, K., Ikeda, M., Torimura, T., Tanabe, N., Aikata, H., et al. (2019) Randomised, Multicentre Prospective Trial of Transarterial Chemoembolisation (TACE) plus Sorafenib as Compared with TACE Alone in Patients with Hepatocellular Carcinoma: TACTICS Trial. Gut, 69, 1492-1501. [Google Scholar] [CrossRef] [PubMed]
[27] Kudo, M., Ueshima, K., Ikeda, M., Torimura, T., Tanabe, N., Aikata, H., et al. (2022) Final Results of TACTICS: A Randomized, Prospective Trial Comparing Transarterial Chemoembolization plus Sorafenib to Transarterial Chemoembolization Alone in Patients with Unresectable Hepatocellular Carcinoma. Liver Cancer, 11, 354-367. [Google Scholar] [CrossRef] [PubMed]
[28] Ding, X., Sun, W., Li, W., Shen, Y., Guo, X., Teng, Y., et al. (2021) Transarterial Chemoembolization plus Lenvatinib versus Transarterial Chemoembolization Plus Sorafenib as First‐Line Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Prospective Randomized Study. Cancer, 127, 3782-3793. [Google Scholar] [CrossRef] [PubMed]
[29] Kudo, M., Finn, R.S., Qin, S., Han, K., Ikeda, K., Piscaglia, F., et al. (2018) Lenvatinib versus Sorafenib in First-Line Treatment of Patients with Unresectable Hepatocellular Carcinoma: A Randomised Phase 3 Non-Inferiority Trial. The Lancet, 391, 1163-1173. [Google Scholar] [CrossRef] [PubMed]
[30] Bruix, J., Qin, S., Merle, P., Granito, A., Huang, Y., Bodoky, G., et al. (2017) Regorafenib for Patients with Hepatocellular Carcinoma Who Progressed on Sorafenib Treatment (RESORCE): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. The Lancet, 389, 56-66. [Google Scholar] [CrossRef] [PubMed]
[31] Abou-Alfa, G.K., Meyer, T., Cheng, A., El-Khoueiry, A.B., Rimassa, L., Ryoo, B., et al. (2018) Cabozantinib in Patients with Advanced and Progressing Hepatocellular Carcinoma. New England Journal of Medicine, 379, 54-63. [Google Scholar] [CrossRef] [PubMed]
[32] Kelley, R., Ryoo, B., Merle, P., Park, J., Bolondi, L., Chan, S.L., et al. (2020) Second-line Cabozantinib after Sorafenib Treatment for Advanced Hepatocellular Carcinoma: A Subgroup Analysis of the Phase 3 CELESTIAL Trial. ESMO Open, 5, e000714. [Google Scholar] [CrossRef] [PubMed]
[33] Zhu, A.X., Park, J.O., Ryoo, B., Yen, C., Poon, R., Pastorelli, D., et al. (2015) Ramucirumab versus Placebo as Second-Line Treatment in Patients with Advanced Hepatocellular Carcinoma Following First-Line Therapy with Sorafenib (REACH): A Randomised, Double-Blind, Multicentre, Phase 3 Trial. The Lancet Oncology, 16, 859-870. [Google Scholar] [CrossRef] [PubMed]
[34] Zhu, A.X., Kang, Y., Yen, C., Finn, R.S., Galle, P.R., Llovet, J.M., et al. (2019) Ramucirumab after Sorafenib in Patients with Advanced Hepatocellular Carcinoma and Increased Α-Fetoprotein Concentrations (REACH-2): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. The Lancet Oncology, 20, 282-296. [Google Scholar] [CrossRef] [PubMed]
[35] Kaufman, H.L., Atkins, M.B., Subedi, P., Wu, J., Chambers, J., Joseph Mattingly, T., et al. (2019) The Promise of Immuno-Oncology: Implications for Defining the Value of Cancer Treatment. Journal for ImmunoTherapy of Cancer, 7, 129. [Google Scholar] [CrossRef] [PubMed]
[36] Leone, P., Solimando, A.G., Fasano, R., Argentiero, A., Malerba, E., Buonavoglia, A., et al. (2021) The Evolving Role of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma Treatment. Vaccines, 9, Article 532. [Google Scholar] [CrossRef] [PubMed]
[37] Zeng, Z., Yang, B. and Liao, Z. (2020) Current Progress and Prospect of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma (Review). Oncology Letters, 20, Article No. 45. [Google Scholar] [CrossRef] [PubMed]
[38] El-Khoueiry, A.B., Sangro, B., Yau, T., Crocenzi, T.S., Kudo, M., Hsu, C., et al. (2017) Nivolumab in Patients with Advanced Hepatocellular Carcinoma (Checkmate 040): An Open-Label, Non-Comparative, Phase 1/2 Dose Escalation and Expansion Trial. The Lancet, 389, 2492-2502. [Google Scholar] [CrossRef] [PubMed]
[39] Zhu, A.X., Finn, R.S., Edeline, J., Cattan, S., Ogasawara, S., Palmer, D., et al. (2018) Pembrolizumab in Patients with Advanced Hepatocellular Carcinoma Previously Treated with Sorafenib (KEYNOTE-224): A Non-Randomised, Open-Label Phase 2 Trial. The Lancet Oncology, 19, 940-952. [Google Scholar] [CrossRef] [PubMed]
[40] Qin, S., Ren, Z., Meng, Z., Chen, Z., Chai, X., Xiong, J., et al. (2020) Camrelizumab in Patients with Previously Treated Advanced Hepatocellular Carcinoma: A Multicentre, Open-Label, Parallel-Group, Randomised, Phase 2 Trial. The Lancet Oncology, 21, 571-580. [Google Scholar] [CrossRef] [PubMed]
[41] Marinelli, B., Kim, E., D’Alessio, A., Cedillo, M., Sinha, I., Debnath, N., et al. (2022) Integrated Use of PD-1 Inhibition and Transarterial Chemoembolization for Hepatocellular Carcinoma: Evaluation of Safety and Efficacy in a Retrospective, Propensity Score-Matched Study. Journal for ImmunoTherapy of Cancer, 10, e004205. [Google Scholar] [CrossRef] [PubMed]
[42] Cucarull, B., Tutusaus, A., Rider, P., Hernáez-Alsina, T., Cuño, C., García de Frutos, P., et al. (2022) Hepatocellular Carcinoma: Molecular Pathogenesis and Therapeutic Advances. Cancers, 14, Article 621. [Google Scholar] [CrossRef] [PubMed]
[43] Liu, Z., Tu, K., Wang, Y., Yao, B., Li, Q., Wang, L., et al. (2017) Hypoxia Accelerates Aggressiveness of Hepatocellular Carcinoma Cells Involving Oxidative Stress, Epithelial-Mesenchymal Transition and Non-Canonical Hedgehog Signaling. Cellular Physiology and Biochemistry, 44, 1856-1868. [Google Scholar] [CrossRef] [PubMed]
[44] Han, Z., Yang, F., Zhang, Y., Wang, J., Ni, Q., Zhu, H., et al. (2022) Prognostic Efficacy and Prognostic Factors of TACE plus TKI with ICIs for the Treatment of Unresectable Hepatocellular Carcinoma: A Retrospective Study. Frontiers in Oncology, 12, Article 1029951. [Google Scholar] [CrossRef] [PubMed]
[45] Long, Y., Huang, J., Liao, J., Zhang, D., Huang, Z., He, X., et al. (2023) Safety and Survival Outcomes of Liver Resection Following Triple Combination Conversion Therapy for Initially Unresectable Hepatocellular Carcinoma. Cancers, 15, Article 5878. [Google Scholar] [CrossRef] [PubMed]
[46] Feng, J., Liu, Z., Fu, Z., Chai, Z., Sun, J., Wang, K., et al. (2022) Efficacy and Safety of Transarterial Chemoembolization Plus Antiangiogenic-Targeted Therapy and Immune Checkpoint Inhibitors for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus in the Real World. Frontiers in Oncology, 12, Article 954203. [Google Scholar] [CrossRef] [PubMed]
[47] Sun, T., Ren, Y., Sun, B., Chen, L., Zhu, L., Zhang, L., et al. (2023) The Feasibility of TACE Combined with TKIs plus PD-1 Antibody for Advanced HCC. Journal of Hepatocellular Carcinoma, 10, 447-457. [Google Scholar] [CrossRef] [PubMed]
[48] Yuan, Y., He, W., Yang, Z., Qiu, J., Huang, Z., Shi, Y., et al. (2023) TACE-HAIC Combined with Targeted Therapy and Immunotherapy versus TACE Alone for Hepatocellular Carcinoma with Portal Vein Tumour Thrombus: A Propensity Score Matching Study. International Journal of Surgery, 109, 1222-1230. [Google Scholar] [CrossRef] [PubMed]
[49] Huang, Z., Wu, Z., Zhang, L., Yan, L., Jiang, H. and Ai, J. (2024) The Safety and Efficacy of TACE Combined with HAIC, PD-1 Inhibitors, and Tyrosine Kinase Inhibitors for Unresectable Hepatocellular Carcinoma: A Retrospective Study. Frontiers in Oncology, 14, Article 1298122. [Google Scholar] [CrossRef] [PubMed]
[50] Li, L., He, J., Xie, Y.X., et al. (2022) A Retrospective Controlled Study of TACE-HAIC-Targeted-Immune Quadruple Therapy for Intermediate and Advanced-Stage Hepatocellular Carcinoma. Chinese Journal of Hepatology, 30, 939-946.
[51] Pang, B., Zuo, B., Huang, L., You, X., Liu, T., Hao, J., et al. (2024) Real-world Efficacy and Safety of TACE-HAIC Combined with TKIs and PD-1 Inhibitors in Initially Unresectable Hepatocellular Carcinoma. International Immunopharmacology, 137, Article ID: 112492. [Google Scholar] [CrossRef] [PubMed]
[52] Liu, C., Li, T., He, J. and Shao, H. (2020) TACE Combined with Microwave Ablation Therapy vs. TACE Alone for Treatment of Early-and Intermediate-Stage Hepatocellular Carcinomas Larger than 5 Cm: A Meta-Analysis. Diagnostic and Interventional Radiology, 26, 575-583. [Google Scholar] [CrossRef] [PubMed]