首页 中华肝胆外科杂志 2024年30卷11期 晚期肝细胞癌免疫靶向联合转化序贯外科治疗专家共识(2024版)
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晚期肝细胞癌免疫靶向联合转化序贯外科治疗专家共识(2024版)
中华预防医学会肝胆胰疾病预防与控制专业委员会 
中国抗癌协会肝癌专业委员会
北京医学会外科学分会肝脏学组
中华肝胆外科杂志编辑委员会
作者及单位信息
·
DOI： 10.3760/cma.j.cn113884-20240814-00245
Expert consensus on the sequential surgery following conversion therapy based on the combination of immune checkpoint inhibitors and antiangiogenic targeted drugs for advanced hepatocellular carcinoma (2024 edition)
Professional Committee for Prevention and Control of Hepatobiliary and Pancreatic Diseases of Chinese Preventive Medicine Association
Chinese Society of Liver Cancer
Liver Study Group of Surgery Committee of Beijing Medical Association
Editorial Board of the Chinese Journal of Hepatobiliary Surgery
Lu Shichun
Cai Jianqiang
Authors Info & Affiliations
Professional Committee for Prevention and Control of Hepatobiliary and Pancreatic Diseases of Chinese Preventive Medicine Association
Chinese Society of Liver Cancer
Liver Study Group of Surgery Committee of Beijing Medical Association
Editorial Board of the Chinese Journal of Hepatobiliary Surgery
Lu Shichun
Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army, Beijing 100853, China
Cai Jianqiang
Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
·
DOI： 10.3760/cma.j.cn113884-20240814-00245
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摘要
多达半数的肝细胞癌患者初诊时即为晚期，而对于晚期肝细胞癌尚缺乏有效的根治性治疗措施，患者预后较差。近年来，免疫检查点抑制剂联合抗血管生成靶向药物治疗晚期肝细胞癌已显示出较高的有效率，显著延长了患者的生存期，也为序贯外科根治性手术提供了可能。经转化治疗后序贯根治性肝切除或肝移植治疗，可使患者获得长期生存获益。为了提高肝癌总体人群的远期生存率，实现《"健康中国2030"规划纲要》恶性肿瘤总体5年生存率提高15%的目标，中华预防医学会肝胆胰疾病预防与控制专业委员会、中国抗癌协会肝癌专业委员会、北京医学会外科学分会肝脏学组组织国内相关专业专家，就《基于免疫联合靶向方案的晚期肝细胞癌转化治疗中国专家共识(2021版)》发布以来新的进展进行了深入的讨论，并就相关要点的修改、增补达成新的共识，以进一步指导临床实践，规范医疗行为，推动学科发展。
癌，肝细胞;分子靶向治疗;肝切除术;免疫检查点抑制剂;转化治疗
ABSTRACT
Up to half of patients with hepatocellular carcinoma (HCC) in China are diagnosed at an advanced stage and often with a dismal prognosis. More effective treatment strategies are mandatory. In recent years, the combination of immune checkpoint inhibitors and anti-angiogenic targeted therapy has shown a promising treatment effect in advanced HCC with prolonged survival of patients, which also offered an opportunity for sequential curative surgery. Sequential curative hepatectomy or liver transplantation following conversion therapy brings survival benefits to patients. Aiming to improve the long-term survival of overall population with liver cancer and contribute to the goal of a 15% increase in the 5-year survival of overall cancer patients outlined in the "Healthy China 2030" blueprints, the Professional Committee for Prevention and Control of Hepatobiliary and Pancreatic Diseases of Chinese Preventive Medicine Association, Chinese Society of Liver Cancer, and the Liver Study Group of Surgery Committee of Beijing Medical Association organized in-depth discussions among relevant domestic experts. These discussions focus on the latest progress since the release of Chinese expert consensus on conversion therapy of immune checkpoint inhibitors combined antiangiogenic targeted drugs for advanced hepatocellular carcinoma (2021 edition) and have reached new consensus on the modifications and supplements to some key points. This consensus aims to further guide clinical practice, standardize medical protocol, and usher the new development in liver surgery.
Carcinoma, hepatocellular;Molecular targeted therapy;Hepatectomy;Immune checkpoint inhibitors;Conversion therapy
Lu Shichun, Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army, Beijing 100853, China, Email:
mocdef.3ab61103_csul;
Cai Jianqiang, Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China, Email:
nc.defcaab.smacicgnaiqnaijiac
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引用本文
中华预防医学会肝胆胰疾病预防与控制专业委员会,中国抗癌协会肝癌专业委员会,北京医学会外科学分会肝脏学组,等. 晚期肝细胞癌免疫靶向联合转化序贯外科治疗专家共识(2024版)[J]. 中华肝胆外科杂志,2024,30(11)：801-812.
DOI:10.3760/cma.j.cn113884-20240814-00245PERMISSIONS
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肝癌是高发病率、高致死率的恶性疾病，中国的年新发病例为36.77万，年新增致死病例高达31.65万
[
1
]。肝细胞癌是肝癌的主要类型，占原发性肝癌总数的75.0%～90.0%
[
2
,
3
]。由于肝癌起病隐匿，疾病早期多数无临床症状，多达半数的肝细胞癌患者初诊即被诊断为晚期
[
4
]。本共识中的晚期肝细胞癌定义参照《原发性肝癌诊疗指南(2024年版)》与巴塞罗那临床肝癌(Barcelona clinic liver cancer, BCLC)分期，即伴有影像学可见血管癌栓或肝外转移的肝细胞癌，对应的中国肝癌分期(China liver cancer staging, CNLC)Ⅲa和Ⅲb期或BCLC-C期。
肝癌患者首诊时只有不到30%适合根治性手术治疗，而晚期肝细胞癌缺乏根治性治疗手段，预后较差
[
5
]。现行各指南体系下，晚期肝癌患者的诊疗普遍推荐为非手术治疗，而非以治愈为目的的根治性手术。根据指南，CNLC Ⅲa期肝癌尤其是合并门静脉主干癌栓的患者，应以经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization, TACE)或TACE联合系统抗肿瘤治疗为治疗首选，仅有极少数情况在经多学科讨论后可考虑手术切除，伴肝外转移的CNLC Ⅲb期肝细胞癌则推荐首选系统抗肿瘤治疗、局部治疗等
[
3
]。欧洲肝脏研究学会指南和BCLC分期则将系统抗肿瘤治疗作为BCLC-C期肝癌患者的唯一治疗推荐
[
5
,
6
]。随着系统抗肿瘤治疗的发展进步，尤其是以免疫检查点抑制剂(immune checkpoint inhibitor, ICI)联合抗血管生成靶向药物(antiangiogenic targeted drug, AATD)为代表的联合方案疗效表现突出。现有多个指南已将ICI联合AATD作为晚期肝细胞癌一线治疗的优先推荐
[
3
,
7
,
8
]。相关治疗格局的改变在带来系统抗肿瘤治疗下更长生存获益的同时，也为晚期肝细胞癌患者的降期转化及序贯外科手术提供了更多可能
[
9
]。
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备注信息
A
卢实春，解放军总医院肝胆胰外科医学部，北京 100853，Email：
mocdef.3ab61103_csul；
B
蔡建强，中国医学科学院肿瘤医院肝胆外科，北京 100021，Email：
nc.defcaab.smacicgnaiqnaijiac
C
国际实践指南注册与透明化平台，PREPARE-2024CN846
D
Practice Guideline Registration for Transparency, PREPARE-2024CN846
E
所有编者均声明不存在利益冲突
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感谢徐晓晨、李俊锋、李雪瑞、曹银彪、焦天宇、王方舟在文献检索与资料整理方面提供的帮助
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