Research progress in the treatment of hepatocellular carcinoma with portal vein tumor thrombosis
-
摘要: 肝细胞癌（hepatocellular carcinoma，HCC）是中国常见恶性肿瘤，其死亡率居恶性肿瘤前列。门静脉癌栓（portal vein tumor thrombosis，PVTT）是HCC常见的临床表现和重要的预后不良因素，HCC合并门静脉癌栓患者的肝功能及体能状态、肿瘤是否可切除、PVTT分型以及有无远处转移是制订治疗决策的重要考虑因素。国内指南和专家共识对部分HCC合并PVTT患者推荐外科手术，而其他多数患者则主要接受系统治疗、介入、放疗等姑息治疗。近年，针对HCC合并PVTT，在可手术切除患者的围手术期治疗、不可切除患者的姑息治疗以及转化治疗方面开展了较多的临床研究和探索，HCC多学科诊疗模式也在临床中提倡并推广。本文回顾了近年HCC合并PVTT的相关文献，就其进展进行综述。Abstract: Hepatocellular carcinoma (HCC)—a common malignant carcinoma in China—has a high mortality rate nationwide. Portal vein tumor thrombosis (PVTT) is a common clinical manifestation and a critical poor prognostic factor of HCC. In patients with HCC and PVTT, liver function and physical status, tumor resectability, PVTT classification, and presence of distant metastasis are important considerations during treatment decisions. Domestic guidelines and expert consensus recommend surgery for patients with partial HCC and PVTT, while most other patients mainly receive systematic therapy, interventional therapy, radiotherapy, and other palliative treatments. Recently, many clinical studies and explorations have been conducted on perioperative treatments for patients with resectable HCC and PVTT and palliative and translational treatments for patients with unresectable HCC. The clinical application of multidisciplinary modalities for patients with HCC is also increasingly advocated and promoted. This study reviews the progress in the treatment of HCC with PVTT.
-
表 1 PVTT分型中国程氏分型和日本的VP分型
门静脉癌栓累及分支部位 微血管癌栓 三级分支 二级分支 一级分支 主干 肠系膜上静脉 程氏分型 Ⅰ0型 Ⅰ型 Ⅰ型 Ⅱ型 Ⅲ型 Ⅳ型 VP分型 VP1型 VP2型 VP3型 VP4型（主干或对侧一级分支） 
下载: 导出CSV
-
[1] Park JW, Chen MS, Colombo M, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study[J]. Liver Int, 2015, 35(9):2155-2166. doi: 10.1111/liv.12818 [2] 中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗规范(2019年版)[J].肿瘤综合治疗电子杂志,2020,6(2):55-85. [3] 吴孟超,程树群,陈敏山,等.肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版)[J].中华消化外科杂志,2016,15(5):411-416. [4] Wang K, Guo WX, Chen MS, et al. Multimodality treatment for hepatocellular carcinoma with portal vein tumor thrombus a large-scale, multicenter, propensity mathching score analysis[J]. Medicine, 2016, 95(11):e3015. doi: 10.1097/MD.0000000000003015 [5] Wei XB, Jiang YB, Zhang XP, et al. Neoadjuvant three-dimensional conformal radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: a randomized, open-label, multicenter controlled study[J]. J Clin Oncol, 2019, 37(24):2141-2151. doi: 10.1200/JCO.18.02184 [6] Li N, Feng S, Xue J, et al. Hepatocellular carcinoma with main portal vein tumor thrombus: a comparative study comparing hepatectomy with or without neoadjuvant radiotherapy[J]. HPB (Oxford), 2016, 18(6):549-556. doi: 10.1016/j.hpb.2016.04.003 [7] Zhang YF, Guo RP, Zou RH, et al. Efficacy and safety of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: a prospective comparative study[J]. Eur Radiol, 2016, 26(7):2078-2088. doi: 10.1007/s00330-015-4021-8 [8] Zhang XP, Gao YZ, Chen ZH, et al. An eastern hepatobiliary surgery hospital/portal vein tumor thrombus scoring system as an aid to decision making on hepatectomy for hepatocellular carcinoma patients with portal vein tumor thrombus: a multicenter study[J]. Hepatology, 2019, 69(5):2076-2090. doi: 10.1002/hep.30490 [9] Liu S, Guo L, Li H, et al. Postoperative Adjuvant Trans-Arterial Chemoembolization for Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus[J]. Ann Surg Oncol, 2018, 25(7):2098-2104. doi: 10.1245/s10434-018-6438-1 [10] Hatano E, Uemoto S, Yamaue H, et al. Significance of hepatic resection and adjuvant hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombus in the first branch of portal vein and the main portal trunk: a project study for hepatic surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery[J]. J Hepatobiliary Pancreat Sci, 2018, 25(9):395-402. doi: 10.1002/jhbp.574 [11] Sun JX, Yang L, Shi J, et al. Postoperative adjuvant IMRT for patients with HCC and portal vein tumor thrombus: An open-label randomized controlled trial[J]. Radiother Oncol, 2019, 140:20-25. doi: 10.1016/j.radonc.2019.05.006 [12] Chen JH, Lu L, Wen TF, et al. Adjuvant lenvatinib in combination with TACE for hepatocellular carcinoma patients with high risk of postoperative relapse (LANCE): Interim results from a muticenter prospective cohort study[J]. J Clin Oncol, 2020, 38(15):4580-4580. [13] Zhao H, Zhao JJ, Jiang L, et al. Anti-PD-1 antibody SHR-1210 combined with apatinib as adjuvant treatment in patients with hepatocellular carcinoma at high risk of recurrence after radical resection: Preliminary results from a multicenter, randomized, controlled phase Ⅱ trial[J]. J Clin Oncol, 2021, 39(3_suppl):285. [14] Kaneko S, Tsuchiya K, Yasui Y, et al. Strategy for advanced hepatocellular carcinoma based on liver function and portal vein tumor thrombosis[J]. Hepatol Res, 2020, 50(12):1375-1385. doi: 10.1111/hepr.13567 [15] Kuzuya T, Ishigami M, Ito T, et al. Sorafenib vs. lenvatinib as first-line therapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis[J]. Anticancer Res, 2020, 40(4):2283-2290. doi: 10.21873/anticanres.14193 [16] Kuo YH, Wu IP, Wang JH, et al. The outcome of sorafenib monotherapy on hepatocellular carcinoma with portal vein tumor thrombosis[J]. Invest New Drugs, 2018, 36(2):307-314. doi: 10.1007/s10637-017-0468-6 [17] Qin SK, Ren ZG, Feng YH, et al. Atezolizumab plus bevacizumab versus sorafenib in the Chinese subpopulation with unresectable hepatocellular carcinoma: phase 3 randomized, open-label IMbrave150 study[J]. Liver Cancer, 2021, 10(4):296-308. doi: 10.1159/000513486 [18] Ren ZG, Xu JM, Bai YX, et al. Sintilimab plus a bevacizumab biosimilar (IBI305) versus sorafenib in unresectable hepatocellular carcinoma (ORIENT-32): a randomised, open-label, phase 2-3 study (vol 22, pg 977, 2021)[J]. Lancet Oncol, 2021, 22(8):E347-E347. [19] Breder VV, Vogel A, Merle P, et al. IMbrave150: Exploratory efficacy and safety results of hepatocellular carcinoma (HCC) patients (pts) with main trunk and/or contralateral portal vein invasion (Vp4) treated with atezolizumab (atezo) plus bevacizumab (bev) versus sorafenib (sor) in a global Ph III study[J]. J Clin Oncol, 2021, 39(15):4073. [20] Yuan GS, Cheng X, Li Q, et al. Safety and efficacy of camrelizumab combined with apatinib for advanced hepatocellular carcinoma with portal vein tumor thrombus: a multicenter retrospective study[J]. Onco Targets Ther, 2020, 13:12683-12693. doi: 10.2147/OTT.S286169 [21] Xiang X, Lau WY, Wu ZY, et al. Transarterial chemoembolization versus best supportive care for patients with hepatocellular carcinoma with portal vein tumor thrombus: a multicenter study[J]. Eur J Surg Oncol, 2019, 45(8):1460-1467. doi: 10.1016/j.ejso.2019.03.042 [22] Lv WF, Liu KC, Lu D, et al. Transarterial chemoembolization for hepatocellular carcinoma combined with portal vein tumor thrombosis[J]. Cancer Manag Res, 2018, 10:4719-4726. doi: 10.2147/CMAR.S166527 [23] Yang JF, Lo CH, Lee MS, et al. Stereotactic ablative radiotherapy versus conventionally fractionated radiotherapy in the treatment of hepatocellular carcinoma with portal vein invasion: a retrospective analysis[J]. Radiat Oncol, 2019, 14(1):180. doi: 10.1186/s13014-019-1382-1 [24] Shui YJ, Yu W, Ren XQ, et al. Stereotactic body radiotherapy based treatment for hepatocellular carcinoma with extensive portal vein tumor thrombosis[J]. Radiat Oncol, 2018, 13(1):188. doi: 10.1186/s13014-018-1136-5 [25] Vilgrain V, Pereira H, Assenat E, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial[J]. Lancet Oncol, 2017, 18(12):1624-1636. doi: 10.1016/S1470-2045(17)30683-6 [26] Facciorusso A, Bargellini I, Cela M, et al. Comparison between Y90 radioembolization plus sorafenib and Y90 radioembolization alone in the treatment of hepatocellular carcinoma: a propensity score analysis[J]. Cancers (Basel), 2020, 12(4):897. doi: 10.3390/cancers12040897 [27] Lyu N, Zhao M. Hepatic arterial infusion chemotherapy of oxaliplatin plus fluorouracil versus sorafenib in advanced hepatocellular carcinoma: A biomolecular exploratory, randomized, phase 3 trial (The FOHAIC-1 study)[J]. J Clin Oncol, 2021, 39(15_suppl): 4007. [28] Li MF, Leung HWC, Chan ALF, et al. Network meta-analysis of treatment regimens for inoperable advanced hepatocellular carcinoma with portal vein invasion[J]. Ther Clin Risk Manag, 2018, 14:1157-1168. doi: 10.2147/TCRM.S162898 [29] Kim YJ, Jung J, Joo JH, et al. Combined transarterial chemoembolization and radiotherapy as a first-line treatment for hepatocellular carcinoma with macroscopic vascular invasion: Necessity to subclassify Barcelona Clinic Liver Cancer stage C[J]. Radiother Oncol, 2019, 141:95-100. doi: 10.1016/j.radonc.2019.08.009 [30] Yoon SM, Ryoo BY, Lee SJ, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs. sorafenib in hepatocellular carcinoma with macroscopic vascular invasion a randomized clinical trial[J]. JAMA Oncol, 2018, 4(5):661-669. doi: 10.1001/jamaoncol.2017.5847 [31] Li XL, Guo WX, Guo L, et al. Should transarterial chemoembolization be given before or after intensity-modulated radiotherapy to treat patients with hepatocellular carcinoma with portal vein tumor thrombus? A propensity score matching study[J]. Oncotarget, 2018, 9(36):24537-24547. doi: 10.18632/oncotarget.25224 [32] Kosaka Y, Kimura T, Kawaoka T, et al. Hepatic arterial infusion chemotherapy combined with radiation therapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk or bilobar of the portal vein[J]. Liver Cancer, 2021, 10(2):151-160. doi: 10.1159/000513706 [33] Ding XY, Sun W, Li W, et al. 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[J]. Cancer, 2021, 127(20):3782-3793. doi: 10.1002/cncr.33677 [34] He MK, Li QJ, Zou RH, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs. sorafenib alone for hepatocellular carcinoma with portal vein invasion a randomized clinical trial[J]. JAMA Oncol, 2019, 5(7):953-960. doi: 10.1001/jamaoncol.2019.0250 [35] He MK, Ming S, Lai ZC, et al. A phase Ⅱ trial of lenvatinib plus toripalimab and hepatic arterial infusion chemotherapy as a first-line treatment for advanced hepatocellular carcinoma (LTHAIC study)[J]. J Clin Oncol, 2021, 39(15_suppl):4083. [36] Finn RS, Ikeda M, Zhu AX, et al. Phase Ib study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma[J]. J Clin Oncol, 2020, 38(26):2960-2970. doi: 10.1200/JCO.20.00808 [37] Xu JM, Shen J, Gu SZ, et al. Camrelizumab in combination with apatinib in patients with advanced hepatocellular carcinoma (RESCUE): a for nonrandomized, open-label, phase II trial[J]. Clin Cancer Res, 2021, 27(4):1003-1011. doi: 10.1158/1078-0432.CCR-20-2571 [38] 张雯雯,胡丙洋,韩骏,等.PD-1抑制剂与多靶点酪氨酸激酶抑制剂联合方案用于进展期肝癌转化治疗研究的初步报告[J].中华肝胆外科杂志,2020,26(12):947-948. -
点击查看大图
表(1)
计量
- 文章访问数: 385
- HTML全文浏览量: 170
- PDF下载量: 103
- 被引次数: 0
