Liang Jing, Bai Yi, Ha Fu-Shuang, Luo Ying, Deng Hui-Ting, Gao Ying-Tang
Department of Hepatology, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Nankai University Affiliated Third Center Hospital, Tianjin 300170, China.
Department of Hepatobiliary Surgery, Tianjin First Central Hospital, Tianjin 300192, China.
World J Gastrointest Oncol. 2023 Jan 15;15(1):1-18. doi: 10.4251/wjgo.v15.i1.1.
Improvements in early screening, new diagnostic techniques, and surgical treatment have led to continuous downward trends in hepatocellular carcinoma (HCC) morbidity and mortality rates. However, high recurrence and refractory cancer after hepatectomy remain important factors affecting the long-term prognosis of HCC. The clinical characteristics and prognosis of recurrent HCC are heterogeneous, and guidelines on treatment strategies for recurrent HCC are lacking. Therapies such as surgical resection, radiofrequency ablation, and transhepatic arterial chemoembolization are effective for tumors confined to the liver, and targeted therapy is a very important treatment for unresectable recurrent HCC with systemic metastasis. With the deepening of the understanding of the immune microenvironment of HCC, blocking immune checkpoints to enhance the antitumor immune response has become a new direction for the treatment of HCC. In addition, improvements in the tumor immune microenvironment caused by local treatment may provide an opportunity to improve the therapeutic effect of HCC treatment. Ongoing and future clinical trial data of combined therapy may develop the new treatment scheme for recurrent HCC. This paper reviews the pattern of recurrent HCC and the characteristics of the immune microenvironment, demonstrates the basis for combining local treatment and systemic treatment, and reports current evidence to better understand current progress and future approaches in the treatment of recurrent HCC.
早期筛查、新诊断技术及手术治疗的进步已使肝细胞癌（HCC）的发病率和死亡率持续下降。然而，肝切除术后的高复发率和难治性癌症仍是影响HCC长期预后的重要因素。复发性HCC的临床特征和预后具有异质性，且缺乏复发性HCC治疗策略的指南。手术切除、射频消融及经肝动脉化疗栓塞等治疗方法对局限于肝脏的肿瘤有效，而靶向治疗是不可切除的伴有全身转移的复发性HCC的重要治疗方法。随着对HCC免疫微环境认识的深入，阻断免疫检查点以增强抗肿瘤免疫反应已成为HCC治疗的新方向。此外，局部治疗引起的肿瘤免疫微环境改善可能为提高HCC治疗效果提供契机。联合治疗正在进行的及未来的临床试验数据可能会为复发性HCC制定新的治疗方案。本文综述了复发性HCC的模式及免疫微环境的特征，阐述了局部治疗与全身治疗联合的依据，并报告了当前证据，以更好地了解复发性HCC治疗的当前进展和未来方法。
