Sun Hui-Chuan, Zhu Xiao-Dong
Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China.
Front Oncol. 2021 Nov 18;11:772195. doi: 10.3389/fonc.2021.772195. eCollection 2021.
The high mortality rate associated with hepatocellular carcinoma (HCC) is partly due to the high proportion of patients who present with advanced stage disease at diagnosis, for whom there are limited treatment options. For selected patients with initially unresectable HCC, locoregional and/or systemic treatments can result in tumor downstaging and consequently provide opportunities for surgical intervention and the potential for long-term survival. Therefore, the key aim of 'conversion therapy' is to reduce tumor burden so that patients become amenable to surgical resection. Various therapies have been investigated as candidates for downstaging patients with potentially resectable HCC including transarterial chemoembolization, transarterial radioembolization with yttrium-90 microspheres, radiotherapy, systemic therapies and combination or multimodality treatment approaches. However, downstaging conversion therapy remains controversial and there are several challenges such as defining the criteria used to identify the population of patients who are 'potentially resectable', the criteria used to define successful downstaging, and the optimum treatment approach to maximize the success of downstaging therapy. In this review article, we summarize clinical experience and evidence of downstaging conversion treatment in patients identified as having 'potentially resectable' HCC.
肝细胞癌（HCC）的高死亡率部分归因于诊断时处于晚期疾病阶段的患者比例较高，这类患者的治疗选择有限。对于部分初诊时无法切除的HCC患者，局部和/或全身治疗可使肿瘤降期，从而为手术干预和长期生存提供机会。因此，“转化治疗”的关键目标是减轻肿瘤负荷，使患者适合手术切除。已经对多种疗法进行了研究，作为使潜在可切除HCC患者降期的候选方法，包括经动脉化疗栓塞、钇-90微球经动脉放射性栓塞、放疗、全身治疗以及联合或多模式治疗方法。然而，降期转化治疗仍存在争议，并且存在一些挑战，例如确定用于识别“潜在可切除”患者群体的标准、用于定义成功降期的标准以及使降期治疗成功率最大化的最佳治疗方法。在这篇综述文章中，我们总结了被确定为患有“潜在可切除”HCC患者的降期转化治疗的临床经验和证据。
