肝细胞癌的诊断及治疗进展
Advances in Diagnosis and Treatment of Hepatocellular Carcinoma
DOI: 10.12677/acm.2024.1472075, PDF,    科研立项经费支持
作者: 李金连:内蒙古医科大学附属包头临床医学院,内蒙古 包头;王君艳*:包头市中心医院重症医学科,内蒙古 包头
关键词: 肝细胞诊断治疗结果局部治疗系统治疗Carcinoma Hepatocellular Diagnosis Treatment Outcome Local Treatment Systematic Therapy
摘要: 肝细胞癌是我国临床上常见的恶性肿瘤,占原发性肝癌75%~85%,极高的肿瘤致死率严重威胁国民的身体健康。影像学检查及肿瘤标志物的监测有利于肝细胞癌的诊断,早期肝细胞癌的主要治疗方式为肝切除术,对于晚期肝细胞癌,肝移植是最有效的治疗,近几年,以靶向治疗和免疫治疗为主的系统治疗方式在晚期肝细胞癌的治疗中起到了一定的成效。靶向治疗联合免疫治疗可有效延长患者生存时间,改善预后。新的抗肝细胞癌作用靶点也是该领域近年来的研究热点。本文将总结了肝细胞癌的临床诊断及治疗方法的研究进展,为临床肝细胞癌患者的诊治提供理论依据。
Abstract: Hepatocellular carcinoma is a common malignant tumor in clinical practice in China, accounting for about 75%~85% of primary liver cancer. Its’ extremely high tumor mortality rate seriously threatens the life and health of the people. Imaging examination and tumor marker monitoring are helpful for the diagnosis of hepatocellular carcinoma, the main treatment for early hepatocellular carcinoma is liver resection. For advanced hepatocellular carcinoma, liver transplantation is the most effective treatment. In recent years, targeted therapy and immunotherapy have played a certain role in the treatment of advanced hepatocellular carcinoma. Targeted therapy combined with immunotherapy can effectively prolong patient survival time and improve prognosis. New targets for anti-hepatocellular carcinoma have also been a research hotspot in this field in recent years. This article will summarize the research progress of clinical diagnosis and treatment methods for hepatocellular carcinoma, providing theoretical basis for the diagnosis and treatment of hepatocellular carcinoma patients.
文章引用:李金连, 王君艳. 肝细胞癌的诊断及治疗进展[J]. 临床医学进展, 2024, 14(7): 738-745. https://doi.org/10.12677/acm.2024.1472075

参考文献

[1] 韩家鑫, 徐亮, 等. 肝细胞癌早期筛查和诊断的研究进展[J]. 临床肝胆病杂志, 2023, 39(6): 1468-1475.
[2] Zhou, M., Wang, H., Zeng, X., et al. (2019) Mortality, Morbidity, and Risk Factors in China and Its Provinces, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017. The Lancet, 394, 1145-1158. [Google Scholar] [CrossRef
[3] Chen, W., Zheng, R., Baade, PD., et al. (2016) Cancer Statistics in China, 2015. CA: A Cancer Journal for Clinicians, 66, 115-132. [Google Scholar] [CrossRef] [PubMed]
[4] Pinto, Marques, H., Gomes, Da Silva, S., De Martin, E., et al. (2020) Emerging Biomarkers in HCC Patients: Current Status. International Journal of Surgery, 82, 70-76. [Google Scholar] [CrossRef] [PubMed]
[5] Wang, W. and Wei, C. (2020) Advances in the Early Diagnosis of Hepatocellular Carcinoma. Genes & Diseases, 7, 308-319. [Google Scholar] [CrossRef] [PubMed]
[6] Tzartzeva, K., Obi, J., Rich, N.E., et al. (2020) Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients with Cirrhosis: A Meta-Analysis. Gastroenterology, 154, 1706-1718.E1. [Google Scholar] [CrossRef] [PubMed]
[7] Roberts, L.R., Sirlin, C.B., Zaiem, F., et al. (2021) Imaging for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Hepatology, 67, 401-421. [Google Scholar] [CrossRef] [PubMed]
[8] Nadarevic, T., Collia, A., Giljaca, V., et al. (2022) Magnetic Resonance Imaging for the Diagnosis of Hepatocellular Carcinoma in Adults with Chronic Liver Disease. Cochrane Database of Systematic Reviews, 5, CD014798. [Google Scholar] [CrossRef
[9] Inoue, T., Kudo, M., Komuta, M., et al. (2022) Assessment of Gd-EOB-DTP-enhanced MRI for HCC and Dysplastic Nodules and Comparison of Detection Sensitivity versus MDCT. Journal of Gastroenterology, 47, 1036-1047. [Google Scholar] [CrossRef] [PubMed]
[10] Gao, F., Wei, Y., Zhang, T., et al. (2022) New Liver MR Imaging Hallmarks for Small Hepatocellular Carcinoma Screening and Diagnosing in High-Risk Patients. Frontiers in Oncology, 12, Article 812832. [Google Scholar] [CrossRef] [PubMed]
[11] Wilson, S.R., Kim, T.K., Jang, H.J., et al. (2021) Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI. American Journal of Roentgenology, 189, W7-W12. [Google Scholar] [CrossRef
[12] Fraquelli, M., Nadarevic, T., Colli, A., et al. (2022) Contrast-Enhanced Ultrasound for the Diagnosis of Hepatocellular Carcinoma in Adults with Chronic Liver Disease. Cochrane Database of Systematic Reviews, 9, CD013483. [Google Scholar] [CrossRef
[13] Aubé, C., Oberti, F., Lonjon, J., et al. (2021) EASL and AASLD Recommendations for the Diagnosis of HCC to the Test of Daily Practice. Liver International, 37, 1515-1525. [Google Scholar] [CrossRef] [PubMed]
[14] 谢光军, 郭云虎, 漆兴美, 等. 腹腔镜超声引导下射频消融术治疗小肝癌的相关性研究[J]. 腹腔镜外科杂志, 2014, 19(1): 25-27.
[15] Ganesan, P. and Kulik, L.M. (2023) Hepatocellular Carcinoma: New Developments. Clinical Liver Disease, 27, 85-102. [Google Scholar] [CrossRef] [PubMed]
[16] 江哲龙, 魏志鸿, 张坤, 等. 交替阻断半肝入肝血流在解剖性肝中叶切除术中的应用[J]. 局解手术学杂志, 2019, 28(1): 60-63.
[17] 胡文豪, 王洪东, 沈超楹, 等. 解剖性与非解剖性肝切除治疗原发性肝细胞癌临床疗效比[J]. 中国现代手术学杂志, 2019, 23(3): 172-178.
[18] 黄俊海, 黄磊, 陈彬, 等. 腹腔镜与开腹肝切除术治疗原发性肝细胞癌的疗效对比研究及术后2年复发的影响因素分析[J]. 现代生物医学进展, 2022, 22(19): 3684-3688.
[19] 李照阳. 腹腔镜与开腹肝切除术治疗原发性大肝癌患者疗效比较[J]. 中国民康医学, 2020, 5(32): 11-13.
[20] 郭毅, 王磊, 刘康伟, 等. 机器人辅助与腹腔镜肝切除治疗肝脏肿瘤疗效与安全性的Meta分析[J]. 中国普通外科杂志, 2022, 31(1): 8-21.
[21] Ince, V., Sahin, T., Akbulut, S., et al. (2022) Liver Transplantation for Hepatocellular Carcinoma: Historical Evolution of Transplantation Criteria. World Journal of Clinical Cases, 10, 10413-10427. [Google Scholar] [CrossRef] [PubMed]
[22] Li, J., Yan, LN., Yang, J., et al. (2019) Indicators of Prognosis after Liver Transplantation in Chinese Hepatocellular Carcinoma Patients. World Journal of Gastroenterology, 15, 4170-4176. [Google Scholar] [CrossRef] [PubMed]
[23] Kulik, L., Heimbach, J.K., Zaiem, F., et al. (2018) Therapies for Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation: A Systematic Review and Meta-Analysis. Hepatology, 67, 381-400. [Google Scholar] [CrossRef] [PubMed]
[24] Hasegawa, K., Aoki, T., Ishizawa, T., et al. (2021) Comparison of the Therapeutic Outcomes Between Surgical Resection and Percutaneous Ablation for Small Hepatocellular Carcinoma. Annals of Surgical Oncology, 21, S348-S355. [Google Scholar] [CrossRef] [PubMed]
[25] Feng, Q., Chi, Y., Liu, Y., et al. (2020) Efficacy and Safety of Percutaneous Radiofrequency Ablation versus Surgical Resection for Small Hepatocellular Carcinoma: A Meta-Analysis of 23 Studies. Journal of Cancer Research and Clinical Oncology, 141, 1-9. [Google Scholar] [CrossRef] [PubMed]
[26] 黎欣怡. 危险部位肝癌的射频消融治疗进展[J]. 临床放射学杂志, 2023, 42(10): 1699-1702.
[27] Tumen, D., Heumann, P., Gulowk., et al. (2022) Pathogenesis and Current Treatment Strategies of Hepatocellular Carcinoma. Biomedicines, 10, Article 3202. [Google Scholar] [CrossRef] [PubMed]
[28] Kalogeridi, M.A., Zygogianni, A., Kyrgias, G., et al. (2021) Role of Radiotherapy in the Management of Hepatocellular Carcinoma: A Systematic Review. World Journal of Hepatology, 7, 101-112. [Google Scholar] [CrossRef] [PubMed]
[29] Yin, X.L. and Xu, Q. (2022) Progress in Research on Radiotherapy of Hepatocellular Carcinoma. Modern Oncology, 24, 2989-2992.
[30] Jiang, X., Yang, J.J. and Li, H. (2016) Clinical Effect of Brachy Therapy with 125I Seed Implantation in Treatment of Malignant Hepatopancreatobiliary Tumors. Journal of Clinical Hepatology, 32, 2300-2304.
[31] Li, M.X. and Lv, Yi. (2023) Therapeutic Value of Yttrium-90 Microsphere in the Treatment of Primary Liver Cancer. Modern Oncology, 21, 2859-2863.
[32] Llovet, J.M., Ricci, S., Mazzaferro, V., et al. (2022) Sorafenib in Advanced Hepatocellular Carcinoma. The New England Journal of Medicine, 359, 378-390.
[33] Kudo, M. (2018) Extremely High Objective Response Rate of Lenvatinib: Its Clinical Relevance and Changing the Treatment Paradigm in Hepatocellular Carcinoma. Liver Cancer, 7, 215-224. [Google Scholar] [CrossRef] [PubMed]
[34] Kudo, M., Finn, R.S., Qin, S., 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
[35] Bruix, J., Qin, S., Merle, P., et al. (2017) Regorafenib for Patients with Hepatocellular Carcinoma Who Progressed on Sorafenib Treatment (RESORCE): A Randomised, Double-Blind, Placebocontrolled, Phase 3 Trial. The Lancet, 389, 56-66. [Google Scholar] [CrossRef
[36] Zhu, A.X., Park, J.O., Ryoo, B.Y., et al. (2022) 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
[37] Bi, F., Qin, S., Gu, S., et al. (2020) Donafenib versus Sorafenib as Firstline Therapy in Advanced Hepatocellular Carcinoma: An Openlabel, Randomized, Multicenter Phase Ⅱ/Ⅲ Trial. Journal of Clinical Oncology, 38, Article 4506. [Google Scholar] [CrossRef
[38] Qin, S., Chan, S.L., Sukeepaisarnjaroen, W., et al. (2019) A Phase Ⅱ Study of the Efficacy and Safety of the MET Inhi Bitor Capmatinib (INC280) in Patients with Advanced Hepat Ocellular Carcinoma. Therapeutic Advances in Medical Oncology, 11, 1-12.
[39] Foerster, F., Gairing, S.J., Ilyas, S.I, et al. (2022) Emerging Immunotherapy for HCC: A Guide for Hepatologists. Hepatology, 75, 1604-1626. [Google Scholar] [CrossRef] [PubMed]
[40] Song, X., Kelley, R.K., Khan, A.A, et al. (2023) Exposure-Response Analyses of Tremelimumab Monotherapy or in Combination with Durvalumab in Patients with Unresectable Hepatocellular Carcinoma. Clinical Cancer Research, 29, 754-763. [Google Scholar] [CrossRef
[41] Zhu, A.X., Finn, R.S., Edeline, J., 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.
[42] Qin, S., Ren, Z., Meng, Z., 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
[43] Qin, S., Finn, R.S., Kudo, M., et al. (2019) RATIONALE 301 Study:Tislelizumab versus Sorafenib as First-Line Treatment for Unresectable Hepatocellular Carcinoma. Future Oncology, 15, 1811-1822. [Google Scholar] [CrossRef] [PubMed]
[44] Kraehenbuehl, Weng, C.H., Eghbali, S., et al. (2022) Enhancing Immunotherapy in Cancer by Targeting Emerging Immunomodulatory Pathways. Nature Reviews Clinical Oncology, 19, 37-50. [Google Scholar] [CrossRef] [PubMed]
[45] Kudo, M., Ueshimak, Ikedam, et al. (2020) 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]
[46] Lencionir, R., Llovet, J.M., Han, G., et al. (2016) Sorafenib or Placebo Plus TACE with Doxorubicin-Eluting Beads for Intermediate Stage HCC: The SPACE Trial. Journal of Hepatology, 4, 1090-1098. [Google Scholar] [CrossRef] [PubMed]
[47] He, M.K., Zou, R.H., Li, Q.J., et al. (2018) Phase Ⅱ Study of Sorafenib Combined with Concurrent Hepatic Arterial Infusion of Oxaliplatin, 5-Fluorouracil and Leucovorin for Unresectable Hepatocellular Carcinoma with Major Portal Vein Thrombosis. CardioVascular and Interventional Radiology, 41, 734-743. [Google Scholar] [CrossRef] [PubMed]
[48] Chiang, C.L., Chana, C.Y., Chiuk, W.H., et al. (2019) Combined Stereotactic Body Radiotherapy and Checkpoint Inhibition in Unresectable Hepatocellular Carcinoma: A Potential Synergistic Treatment Strategy. Frontiers in Oncology, 9, Article 1157. [Google Scholar] [CrossRef] [PubMed]