Nishio Takahiro, Yoh Tomoaki, Nishino Hiroto, Ogiso Satoshi, Uchida Yoichiro, Ishii Takamichi, Hatano Etsuro
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Liver Cancer. 2025 Apr 29:1-21. doi: 10.1159/000546138.
Multidisciplinary treatment of hepatocellular carcinoma (HCC) has made notable advancements with the emergence of novel agents for systemic therapies, including receptor tyrosine kinase inhibitors (TKIs) and cancer immuno-oncology (IO) therapy utilizing immune checkpoint inhibitors. Although each of these regimens is effective as monotherapy for advanced HCCs, combining them with locoregional therapy (LRT), such as transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), and radiotherapy (RT), provides an additional antitumor effect. The emergence of novel systemic therapies has given rise to anticipation for the development of multidisciplinary treatments with a combination of systemic therapy and LRT, which aim to achieve curative-intent resection and improve long-term prognosis after resection.
Perioperative combination therapy, a combination of multiple treatment modalities including systemic therapy (TKI and/or IO) and LRT (TACE, HAIC, or RT), is attracting attention as a potentially useful approach for multidisciplinary curative-intent surgical resection or ablation. Currently, there is no evidence-based guidance regarding selection criteria and optimal regimens for perioperative combination therapy. The definition of oncological resectability for HCC is being pursued to establish the indication and protocol for perioperative combination therapy, which broadly encompasses conversion as well as neoadjuvant and adjuvant therapy for intermediate-to-advanced HCC.
Perioperative combination therapy, which positions curative-intent surgical resection or ablation within the combination of multiple modalities including systemic therapy and LRT, provides perspectives for improving the long-term prognosis of patients with initially unresectable HCC and borderline resectable HCC with a high risk of recurrence.
随着新型全身治疗药物的出现，肝细胞癌（HCC）的多学科治疗取得了显著进展，这些药物包括受体酪氨酸激酶抑制剂（TKIs）以及利用免疫检查点抑制剂的癌症免疫肿瘤学（IO）疗法。尽管这些方案中的每一种作为晚期HCC的单一疗法都是有效的，但将它们与局部区域治疗（LRT）联合使用，如经动脉化疗栓塞（TACE）、肝动脉灌注化疗（HAIC）和放疗（RT），可提供额外的抗肿瘤效果。新型全身治疗的出现引发了人们对开发全身治疗与LRT相结合的多学科治疗的期待，其目的是实现根治性切除并改善切除后的长期预后。
围手术期联合治疗，即包括全身治疗（TKI和/或IO）和LRT（TACE、HAIC或RT）在内的多种治疗方式的联合，作为一种可能有助于多学科根治性手术切除或消融的方法正受到关注。目前，关于围手术期联合治疗的选择标准和最佳方案尚无循证指南。正在探索HCC的肿瘤可切除性定义，以确立围手术期联合治疗的适应症和方案，其广泛涵盖了转化治疗以及中晚期HCC的新辅助和辅助治疗。
围手术期联合治疗将根治性手术切除或消融置于包括全身治疗和LRT在内的多种治疗方式的联合之中，为改善初始不可切除HCC和复发风险高的临界可切除HCC患者的长期预后提供了思路。
