Geissler M, Mohr L, Ali M Y, Grimm C F, Ritter M, Blum H E
Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.
Z Gastroenterol. 2003 Nov;41(11):1101-10. doi: 10.1055/s-2003-44304.
Hepatocellular carcinoma (HCC) is one of the major malignancies worldwide. For most patients with advanced or multifocal HCC treatment options are limited resulting in a poor prognosis. Several local ablation methods have been developed as minimally invasive strategies for HCC treatment. It is unclear, until now, whether these therapies will significantly improve the poor prognosis of patients with unresectable HCC. Novel therapeutic strategies and a better understanding of HCC imunobiology are, therefore, urgently required.
The scientific literature since 1970 in all languages cited in Medline was systematically reviewed.
Until now, a variety of specific and non-specific immunostimulatory strategies against HCC has been applied in preclinical experimental models with some promising results. The molecular characterization of HCC associated tumour antigens such as alpha-fetoprotein (AFP) and the increased understanding of the immunological pathways involved in liver and tumor immunology have paved the way for the design of promising gene-based cancer vaccines. The first phase I and II immunotherapeutic clinical trials based on dendritic cell immunotherapy and peptide vaccines are ongoing in HCC-patients. Clinical trials have, in general, demonstrated the safety of such strategies. Recently, exciting new immunological techniques and tools have been developed which allow to characterize antigen specific T cells at a single-cell level. In future, HCC specific tumor rejection antigens which can be used therapeutically have to be identified using microarray-based analysis. The different therapeutic modalities need to be compared directly resulting in optimised therapeutic approaches and the identification of sub-groups of HCC-patients responding favourably to treatment.
肝细胞癌（HCC）是全球主要的恶性肿瘤之一。对于大多数晚期或多灶性HCC患者而言，治疗选择有限，预后较差。已开发出几种局部消融方法作为HCC治疗的微创策略。迄今为止，尚不清楚这些疗法是否会显著改善不可切除HCC患者的不良预后。因此，迫切需要新的治疗策略以及对HCC免疫生物学的更好理解。
对自1970年以来Medline收录的所有语言的科学文献进行系统综述。
迄今为止，多种针对HCC的特异性和非特异性免疫刺激策略已应用于临床前实验模型，并取得了一些有前景的结果。HCC相关肿瘤抗原如甲胎蛋白（AFP）的分子特征以及对肝脏和肿瘤免疫学中涉及的免疫途径的进一步了解，为设计有前景的基因癌症疫苗铺平了道路。基于树突状细胞免疫疗法和肽疫苗的首批I期和II期免疫治疗临床试验正在HCC患者中进行。总体而言，临床试验已证明这些策略的安全性。最近，已开发出令人兴奋的新免疫技术和工具，可在单细胞水平上表征抗原特异性T细胞。未来，需要使用基于微阵列的分析来鉴定可用于治疗的HCC特异性肿瘤排斥抗原。需要直接比较不同的治疗方式，以优化治疗方法并确定对治疗反应良好的HCC患者亚组。
