FOLFOX方案肝动脉灌注化疗及联合治疗在中晚期肝细胞癌中的应用进展

Advances in FOLFOX-Based Hepatic Arterial Infusion Chemotherapy and Combination Therapy for Intermediate to Advanced Hepatocellular Carcinoma

摘要: 在中国，原发性肝癌是常见的消化道肿瘤之一，肝细胞癌(HCC)作为其中主要的类型，手术仍为主要治疗方案，但大部分患者发现时已到中晚期阶段，无法进行根治性手术，可选疗法较少，且预后不理想。肝动脉化疗灌注(HAIC)通过持续输送多种化疗药物至肿瘤部位，提高局部药物浓度并降低全身毒性反应，在中晚期肝细胞癌非手术治疗领域展现了良好的潜力。近年来，我国多采用以奥沙利铂、亚叶酸钙和5-氟尿嘧啶为基础的中国特色FOLFOX方案的肝动脉灌注化疗(FOLFOX HAIC)，现有研究表明其在中晚期HCC中的疗效优于索拉非尼及经导管肝动脉化疗栓塞术(TACE)。此外，FOLFOX HAIC联合经导管肝动脉栓塞术(TAE)、靶向治疗、免疫治疗和放射治疗等均展现出显著的客观缓解率，使部分初始不可切除患者成功实现转化切除。本文将对FOLFOX HAIC在中晚期HCC中的单药及联合治疗模式进行系统综述，以整理其应用现状及研究进展。

Abstract: Primary liver cancer is one of the most common digestive tract malignancies in China, and hepatocellular carcinoma (HCC) represents its predominant pathological type. Although surgical resection remains the mainstay of treatment, the majority of patients are diagnosed at intermediate or advanced stages, rendering radical surgery infeasible. Limited treatment options and poor prognosis pose significant clinical challenges. Hepatic arterial infusion chemotherapy (HAIC), which continuously delivers multiple chemotherapeutic agents directly to the tumor site, can increase local drug concentration while reducing systemic toxicity, and has demonstrated promising potential in the non-surgical treatment of intermediate-to-advanced HCC. In recent years, the Chinese-characteristic FOLFOX regimen—based on oxaliplatin, leucovorin, and 5-fluorouracil—delivered via hepatic arterial infusion (FOLFOX HAIC) has been widely adopted in China. Existing studies have shown that FOLFOX HAIC yields superior efficacy to sorafenib and transcatheter arterial chemoembolization (TACE) in intermediate-to-advanced HCC. Moreover, FOLFOX HAIC combined with transcatheter arterial embolization (TAE), targeted therapy, immunotherapy, or beam radiotherapy has achieved remarkable objective response rates, enabling successful conversion to resectability in some initially unresectable patients. This article systematically reviews monotherapy and combination treatment strategies of FOLFOX HAIC in intermediate-to-advanced HCC, aiming to summarize its current clinical applications and research progress.