Rougier Philippe, Mitry Emmanuel, Barbare Jean-Claude, Taieb Julien
Service d'Hépato-gastroentérologie, Hopital Ambroise Paré, 92100 Boulogne, France.
Semin Oncol. 2007 Apr;34(2 Suppl 1):S12-20. doi: 10.1053/j.seminoncol.2007.01.007.
In the absence of large randomized trials, the current treatment strategy for hepatocellular carcinoma (HCC) remains a matter of choice depending mostly on retrospective studies, experience of centers, and the technical therapeutic possibilities. In fact, treatment decisions must be based on HCC extension and liver function, which is dependent on underlying liver disease. Cirrhosis limits therapeutic choices, life expectancy, and tolerance to therapy. Surgical resection and/or local destruction are the most common curative treatments. Orthotopic liver transplantation is probably the best treatment for small HCC developed in cirrhosis because it treats tumor, cirrhosis, and preneoplastic lesions at the same time. However, this treatment method is feasible in fewer than 5% of cases. Adjuvant treatments include transarterial chemoembolization, chemotherapy, polyprenoic acid, interferon, adoptive immunotherapy, and intra-arterial radioactive lipiodol. Results from trials warrant confirmation in larger randomized trials to show a clear survival benefit on recurrence rate, secondary prevention, and overall survival. Chemoembolization is the only palliative treatment that has been proven to be active, unlike systemic chemotherapy, immunotherapy, and hormone therapy, whose activity is largely questionable and must all be restricted to clinical trials. Possible future therapeutic strategies include epidermal growth factor receptor inhibitors, antivascular endothelial growth factor therapies, cyclin D inhibitors, and HMG-CoA reductase inhibitors.
在缺乏大型随机试验的情况下，目前肝细胞癌（HCC）的治疗策略仍然主要取决于回顾性研究、各中心的经验以及技术治疗可能性，属于一种选择问题。事实上，治疗决策必须基于HCC的扩散程度和肝功能，而肝功能又取决于潜在的肝脏疾病。肝硬化会限制治疗选择、预期寿命以及对治疗的耐受性。手术切除和/或局部毁损是最常见的根治性治疗方法。原位肝移植可能是治疗肝硬化中发生的小HCC的最佳方法，因为它能同时治疗肿瘤、肝硬化和癌前病变。然而，这种治疗方法在不到5%的病例中可行。辅助治疗包括经动脉化疗栓塞、化疗、多聚不饱和脂肪酸、干扰素、过继性免疫疗法以及动脉内放射性碘油。试验结果有待在更大规模的随机试验中得到证实，以明确显示对复发率、二级预防和总生存期有生存获益。与全身化疗、免疫疗法和激素疗法不同，化疗栓塞是唯一已被证明有效的姑息性治疗方法，后三者的有效性大多存疑，必须仅限于临床试验。未来可能的治疗策略包括表皮生长因子受体抑制剂、抗血管内皮生长因子疗法、细胞周期蛋白D抑制剂以及HMG-CoA还原酶抑制剂。
