肿瘤肝脏病学:现代癌症治疗时代的肝脏损伤应对策略

Oncohepatology: Navigating liver injury in the era of modern cancer therapy.

作者信息

Li Shuo-Feng, Ouyang Xu, Feng Shi, Wan Ming-Zhong, Zhou Kai-Nan, Wen Bo-Yuan, Yin Yu-Ze, Yi Hang, Chen Xin-Yuan

机构信息

Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

Shantou University, Shantou 515063, Guangdong Province, China.

出版信息

World J Hepatol. 2025 Jun 27;17(6):106932. doi: 10.4254/wjh.v17.i6.106932.

Abstract

In recent years, the rapid evolution of cancer therapies has markedly increased patient survival rates. However, the incidence of adverse events caused by anticancer treatments remains high, leading to significant clinical challenges. As the central hub of drug metabolism and detoxification, the liver is susceptible to therapeutic insults. The specific mechanisms of liver injury caused by different types of antineoplastic treatments vary. Chemotherapy induces hepatic damage oxidative stress and mitochondrial dysfunction, whereas targeted therapy disrupts signaling pathways in hepatic cells. Immunotherapy triggers immune-mediated hepatitis through cytokine storms and immune cell infiltration, and radiation therapy causes hepatic microvascular injury. Additionally, patients with preexisting chronic liver diseases (such as cirrhosis, hepatitis B/C, or nonalcoholic fatty liver disease) are more likely to face increased risks of hepatic injury during cancer treatment. Therefore, early detection and timely treatment are crucial for these high-risk populations. This review introduces the emerging field of "oncohepatology", which illuminates the mechanisms underlying hepatic injury due to cancer treatments, summarizes the influence and management of preexisting liver disease during cancer treatment, analyzes diagnostic and therapeutic strategies for cancer treatment-associated liver function damage, and discusses potential future research directions to provide valuable insights for liver injury management in clinical oncology.

摘要

近年来,癌症治疗的快速发展显著提高了患者的生存率。然而,抗癌治疗引起的不良事件发生率仍然很高,导致了重大的临床挑战。作为药物代谢和解毒的中心枢纽,肝脏易受治疗性损伤。不同类型的抗肿瘤治疗导致肝损伤的具体机制各不相同。化疗通过氧化应激和线粒体功能障碍诱导肝损伤,而靶向治疗则破坏肝细胞中的信号通路。免疫疗法通过细胞因子风暴和免疫细胞浸润引发免疫介导的肝炎,放射治疗则导致肝微血管损伤。此外,患有慢性肝病(如肝硬化、乙型/丙型肝炎或非酒精性脂肪性肝病)的患者在癌症治疗期间更有可能面临肝损伤风险增加的情况。因此,早期检测和及时治疗对这些高危人群至关重要。本综述介绍了新兴的“肿瘤肝脏病学”领域,阐明了癌症治疗导致肝损伤的潜在机制,总结了癌症治疗期间原有肝病的影响及管理方法,分析了癌症治疗相关肝功能损害的诊断和治疗策略,并探讨了未来潜在的研究方向,为临床肿瘤学中肝损伤的管理提供有价值的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5418/12210168/57fadec3774f/wjh-17-6-106932-g001.jpg

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