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中华普通外科学文献(电子版) ›› 2025, Vol. 19 ›› Issue (03) : 197 -202. doi: 10.3877/cma.j.issn.1674-0793.2025.03.010

综述

肝细胞癌合并门静脉癌栓的治疗进展
邱益霖1, 何坤1,2,()   
  1. 1. 524002 湛江,广东医科大学研究生院
    2. 528400 中山市人民医院肝胆外科
  • 收稿日期:2024-08-03 出版日期:2025-06-01
  • 通信作者: 何坤

Progress in the treatment of hepatocellular carcinoma complicated with portal vein tumor thrombosis

Yilin Qiu1, Kun He1,2,()   

  1. 1. Gruaduate School of Guangdong Medical University, Zhanjiang 524002,China
    2. Department of Hepatobiliary Surgery, Zhongshan City People’s Hospital, Zhongshan 528400, China
  • Received:2024-08-03 Published:2025-06-01
  • Corresponding author: Kun He
引用本文:

邱益霖, 何坤. 肝细胞癌合并门静脉癌栓的治疗进展[J/OL]. 中华普通外科学文献(电子版), 2025, 19(03): 197-202.

Yilin Qiu, Kun He. Progress in the treatment of hepatocellular carcinoma complicated with portal vein tumor thrombosis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2025, 19(03): 197-202.

肝细胞癌(HCC)是世界上常见的恶性肿瘤,大多数患者确诊时已处于疾病中晚期阶段,尤其是合并门静脉癌栓(PVTT)。针对HCC 合并PVTT 的治疗策略并不统一,目前国内外主要采用系统治疗,在综合治疗后部分患者可通过手术切除病灶。本文就相关研究的现状,对HCC 合并PVTT 患者治疗中系统全身治疗、介入治疗、外放射治疗、手术治疗的进展进行综述。

Hepatocellular carcinoma (HCC) is a common malignant tumor in the world, and most patients are at the advanced stage of the disease when diagnosed, especially those with portal vein tumor thrombosis (PVTT).For the treatment of HCC complicated with portal vein cancer thrombus, the treatment strategy is not uniform.At present, systematic treatment is mainly used at home and abroad, and some patients can be surgically resected after systemetic treatment.This article reviews the progress of systemetic treatment, interventional therapy, radiotherapy, surgical treatment for HCC patients with PVTT.

[1]
Bray F, Laversanne M, Sung H, et al.Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin, 2024, 74(3): 229-263.
[2]
European Association for the Study of the Liver.EASL Clinical Practice Guidelines on haemochromatosis[J].J Hepatol, 2022,77(2): 479-502.
[3]
Reig M, Forner A, Rimola J, et al.BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update[J].J Hepatol, 76(3): 681-693.
[4]
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/OL].中华肝脏外科手术学电子杂志,2024, 13(4): 407-449.
[5]
Cheng AL, Guan Z, Chen Z, et al.Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase sorafenib Asia-Pacific trial[J].Eur J Cancer, 2012, 48(10): 1452-1465.
[6]
Ding X, 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.
[7]
Finn RS, Qin S, Ikeda M, et al.Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma[J].N Engl J Med, 2020,382(20): 1894-1905.
[8]
Lee SK, Kwon JH, Lee SW, et al.A real-world comparative analysis of atezolizumab plus bevacizumab and transarterial chemoembolization plus radiotherapy in hepatocellular carcinoma patients with portal vein tumor thrombosis[J].Cancers (Basel),2023, 15(17): 4423.
[9]
Finn RS, Ikeda M, Zhu AX, et al.Phase b study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma[J].J Clin Oncol, 2020, 38(26): 2960-2970.
[10]
Imamura T, Okamura Y, Ohshima K, et al.Hepatocellular carcinoma after a sustained virological response by direct-acting antivirals harbors TP53 inactivation[J].Cancer Med, 2022, 11(8):1769-1786.
[11]
Wang P, Wang X, Liu X, et al.Primary non-response to antiviral therapy affects the prognosis of hepatitis B virus-related hepatocellular carcinoma[J].BMC Cancer, 2023, 23(1): 564.
[12]
Pan D, Liu H N, Yao ZY, et al.Impact of baseline hepatitis B virus viral load on the long-term prognosis of advanced hepatocellular carcinoma treated with immunotherapy[J].World J Gastrointest Oncol, 2024, 16(6): 2504-2519.
[13]
Chen TY, Mai JY, Zhang P, et al.Efficacy of erzhu jiedu recipe on hepatitis B cirrhosis with hyperalphafetoproteinemia: A randomized, double-blind, placebo-controlled clinical trial[J].Medicine (Baltimore), 2021, 100(38): e27231.
[14]
欧阳兵, 冯引凤, 陈江华, 等.健脾化瘀汤联合肝动脉灌注化疗在肝癌合并门静脉癌栓患者中的应用效果[J].中国当代医药, 2025, 32(4): 75-78, 83.
[15]
Peng Z, Fan W, Zhu B, et al.Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase , randomized clinical trial (LAUNCH)[J].J Clin Oncol, 2023, 41(1): 117-127.
[16]
Sun B, Zhang L, Sun T, et al.Safety and efficacy of lenvatinib combined with camrelizumab plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: A two-center retrospective study [J].Front Oncol, 2022, 12: 982948.
[17]
Chen S, Wu Z, Shi F, et al.Lenvatinib plus TACE with or without pembrolizumab for the treatment of initially unresectable hepatocellular carcinoma harbouring PD-L1 expression: A retrospective study[J].J Cancer Res Clin Oncol, 2021, 148(8):2115-2125.
[18]
Teng Y, Ding X, Li W, et al.A retrospective study on therapeutic efficacy of transarterial chemoembolization combined with immune checkpoint inhibitors plus lenvatinib in patients with unresectable hepatocellular carcinoma[J].Technol Cancer Res Treat, 2022, 21:15330338221075174.
[19]
Li X, Fu Z, Chen X, et al.Efficacy and safety of lenvatinib combined with PD-1 inhibitors plus TACE for unresectable hepatocellular carcinoma patients in China real-world[J].Front Oncol, 2022, 12: 950266.
[20]
Zhu XD, Huang C, Shen YH, et al.Downstaging and resection of initially unresectable hepatocellular carcinoma with tyrosine kinase inhibitor and anti-PD-1 antibody combinations[J].Liver Cancer, 2021, 10(4): 320-329.
[21]
Yuan Y, He W, Yang Z, et al.TACE-HAIC combined with targeted therapy and immunotherapy versus TACE alone for hepatocellular carcinoma with portal vein tumour thrombus: A propensity score matching study[J].Int J Surg, 2023, 109(5): 1222-1230.
[22]
Mazzaferro V, Sposito C, Bjoori S, et al.Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: A phase 2 study[J].Hepatology, 2012, 57(5): 1826-1837.
[23]
Liu DM, Leung TW, Chow PK, et al.Clinical consensus statement:selective internal radiation therapy with yttrium 90 resin microspheres for hepatocellular carcinoma in Asia[J].Int J Surg,2022, 102: 106094.
[24]
Kim PH, Choi Sh, Kim JH, et al.Comparison of radioembolization and sorafenib for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis: A systematic review and metaanalysis of safety and efficacy[J].Korean J Radiol, 2019, 20(3):385-398.
[25]
Han S, Choi HJ, Beom SH, et al.Treatment efficacy by hepatic arterial infusion chemotherapy vs.sorafenib after liver-directed concurrent chemoradiotherapy for advanced hepatocellular carcinoma[J].J Cancer Res Clin Oncol, 2021, 147(10): 3123-3133.
[26]
Lee HA, Park S, Seo YS, et al.Benefits of local treatment including external radiotherapy for hepatocellular carcinoma with portal invasion[J].Biology (Basel), 2021, 10(4): 326.
[27]
Lee HA, Seo YS, Shin IS, et al.Efficacy and feasibility of surgery and external radiotherapy for hepatocellular carcinoma with portal invasion: A meta-analysis[J].Int J Surg, 2022, 104: 106753.
[28]
Zhang XF, Lai L, Zhou H, et al.Stereotactic body radiotherapy plus transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma patients with portal vein tumour thrombus: A meta-analysis[J].PLoS One, 2022, 17(5): e0268779.
[29]
Ji X, Xu Z, Sun J, et al.Lenvatinib with or without stereotactic body radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: A retrospective study[J].Radiat Oncol, 2023.18(1): 101.
[30]
Chen SW, Lin LC, Kuo YC, et al.Phase 2 study of combined sorafenib and radiation therapy in patients with advanced hepatocellular carcinoma[J].Int J Radiat Oncol Biol Phys, 2014,88(5): 1041-1047.
[31]
Sanuki N, Takeda A, Kunieda E.Role of stereotactic body radiation therapy for hepatocellular carcinoma[J].World J Gastroenterol,2014, 20(12): 3100-3111.
[32]
Hsu C, Chen BB, Chen CH, et al.Consensus development from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)[J].Liver Cancer, 2015, 4(2): 96-105.
[33]
Kokudo T, Hasegawa K, Matsuyama Y, et al.Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion[J].J Hepatol, 2016, 65(5): 938-943.
[34]
Zhu XD, Huang C, Shen YH, et al.Hepatectomy after conversion therapy using tyrosine kinase inhibitors plus anti-PD-1 antibody therapy for patients with unresectable hepatocellular carcinoma[J].Ann Surg Oncol, 2023, 30(5): 2782-2790.
[35]
Liu PH, Huo TI, Miksad RA.Hepatocellular carcinoma with portal vein tumor involvement: best management strategies[J].Semin Liver Dis, 2018, 38(3): 242-251.
[36]
Li W, You X, Li L, et al.Hepatic resection for hepatocellular carcinoma involving a single large tumor, multiple tumors or macrovascular invasion[J].Zhonghua Yi Xue Za Zhi, 2015, 95(38):3115-3118.
[37]
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.
[38]
林巧, 周丽.RFA 联合LAH 术治疗原发性肝癌并门静脉癌栓的临床效果分析[J/OL].中华普外科手术学杂志(电子版),2024, 18(5): 521-524.
[39]
Hou G, Zhang F, Feng X, et al.Neoadjuvant-based triple therapy for hepatocellular carcinoma with type / portal vein tumor thrombosis[J].J Hepatocell Carcinoma, 2024, 11: 1581-1595.
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