Department of Gastrointestinal Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio 44118, USA.
Oncology. 2010;78(3-4):161-71. doi: 10.1159/000315577. Epub 2010 Jun 8.
The only curative treatment option for hepatocellular carcinoma patients is either a surgical resection or liver transplantation. Due to limited supply of donor organs and the stringent selection criteria for liver transplantation, resection is the mainstay of therapy, particularly for patients with preserved liver function and small tumors with no portal hypertension. However, tumor recurrences and subsequent death is common after resection, which has prompted a search for an effective adjuvant therapy to improve patient outcomes. Studies have looked at various adjuvant treatment modalities, including systemic chemotherapy, intra-arterial approaches with or without chemotherapy, and the use of cytokines, but there is still no established role for adjuvant therapy after a curative liver resection. Unfortunately, many of these trials lack adequate sample sizes, and are heterogeneous in the patient populations and study end points, thereby limiting robust conclusions. Based on current available data, the role of adjuvant therapy after liver resection needs to be further investigated. The use of molecular targeted therapy focusing on the vascular endothelial growth factor pathway appears to be a promising step. Clinical trials assessing adjuvant therapies after a curative liver resection are urgently needed. These should ideally be prospective, randomized trials with properly selected patients and appropriate end points.
对于肝细胞癌患者，唯一的治愈性治疗选择是手术切除或肝移植。由于供体器官的供应有限，以及肝移植的严格选择标准，切除是主要的治疗方法，特别是对于肝功能正常和无门静脉高压的小肿瘤患者。然而，手术后肿瘤复发和随后的死亡是常见的，这促使人们寻找有效的辅助治疗方法来改善患者的预后。研究已经研究了各种辅助治疗方法，包括全身化疗、动脉内治疗联合或不联合化疗，以及细胞因子的使用，但在根治性肝切除术后辅助治疗的作用仍未确定。不幸的是，许多这些试验缺乏足够的样本量，并且在患者人群和研究终点方面存在异质性，从而限制了结论的可靠性。基于目前可用的数据，需要进一步研究肝切除术后辅助治疗的作用。针对血管内皮生长因子通路的分子靶向治疗的使用似乎是一个很有前途的步骤。需要进行评估根治性肝切除术后辅助治疗的临床试验。这些试验最好是前瞻性、随机试验，选择合适的患者和适当的终点。
