Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Front Med. 2021 Apr;15(2):155-169. doi: 10.1007/s11684-021-0848-3. Epub 2021 Mar 23.
Hepatic resection represents the first-line treatment for patients with resectable hepatocellular carcinoma (HCC). However, the 5-year recurrence rates of HCC after surgery have been reported to range from 50% to 70%. In this review, we evaluated the available evidence for the efficiency of adjuvant treatments to prevent HCC recurrence after curative liver resection. Antiviral therapy has potential advantages in terms of reducing the recurrence rate and improving the overall survival (OS) and/or disease-free survival of patients with hepatitis-related HCC. Postoperative adjuvant transarterial chemoembolization can significantly reduce the intrahepatic recurrence rate and improve OS, especially for patients with a high risk of recurrence. The efficacy of molecular targeted drugs as an adjuvant therapy deserves further study. Adjuvant adoptive immunotherapy can significantly improve the clinical prognosis in the early stage. Randomized controlled trial (RCT) studies evaluating adjuvant immune checkpoint inhibitors are ongoing, and the results are highly expected. Adjuvant hepatic artery infusion chemotherapy might be beneficial in patients with vascular invasion. Huaier granule, a traditional Chinese medicine, has been proved to be effective in prolonging the recurrence-free survival and reducing extrahepatic recurrence. The efficiency of other adjuvant treatments needs to be further confirmed by large RCT studies.
肝切除术是可切除肝细胞癌（HCC）患者的一线治疗方法。然而，手术后 HCC 的 5 年复发率据报道在 50%至 70%之间。在这篇综述中，我们评估了辅助治疗预防根治性肝切除术后 HCC 复发的有效性的现有证据。抗病毒治疗在降低复发率以及改善与肝炎相关的 HCC 患者的总生存率（OS）和/或无病生存率方面具有潜在优势。术后辅助经动脉化疗栓塞术（TACE）可显著降低肝内复发率并改善 OS，尤其是对复发风险较高的患者。分子靶向药物作为辅助治疗的疗效值得进一步研究。辅助过继免疫疗法可显著改善早期的临床预后。正在进行评估辅助免疫检查点抑制剂的随机对照试验（RCT）研究，结果备受期待。辅助肝动脉灌注化疗可能对有血管侵犯的患者有益。华蟾素颗粒是一种中药，已被证明可有效延长无复发生存期并减少肝外复发。其他辅助治疗的疗效需要通过大型 RCT 研究进一步证实。
