Chen Zhu, Chen Xingyu, Hu Haiyang, Chen Kai, Xiao Heng, Du Chengyou, Lan Xiang
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Gastrointest Oncol. 2025 Aug 30;16(4):1736-1748. doi: 10.21037/jgo-2025-204. Epub 2025 Aug 18.
Conversion therapy has been a hot field of hepatocellular carcinoma (HCC). The combination of interventional hepatoma therapy, targeted therapy and immunotherapy is an emerging conversion therapy, but its conversion efficiency has not been demonstrated. Its emergence limited the use of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The way of turning unresectable tumors into resectable tumors is being explored. We integrated the ALPPS, interventional hepatoma therapy, targeted therapy, immunotherapy and proposed a novel conversion therapy named AITI.
Patients treated with the AITI conversion therapy model in The First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. ALPPS was selected for patients who, after physician evaluation, were considered potentially resectable but had insufficient future liver remnant (FLR). Interventional hepatoma therapy, targeted therapy, and immunotherapy were used before first-stage ALPPS or between stages. Five patients received AITI conversion therapy model. Three patients underwent traditional conversion therapy between the two stages of the ALPPS and achieved satisfactory hypertrophy, while two patients achieved radical resection through ALPPS following conversion therapy. Among all patients, the mean residual volume before the first-stage surgery was 580±245 mL, and increased to 701±295 mL before the second-stage surgery. The mean duration of the first-stage surgery was 175.00±17.32 minutes with a blood loss of 210.00±124.50 mL. For the second-stage surgery, the mean duration was 234.00±25.35 minutes with a blood loss of 400.00±70.71 mL. The average duration of treatment was 136.8±98.3 days.
The AITI conversion therapy model is safe and affective. This approach can provide more opportunities for unresectable patients to achieve radical resection.
转化治疗一直是肝细胞癌（HCC）的热门领域。介入性肝癌治疗、靶向治疗和免疫治疗的联合是一种新兴的转化治疗方法，但其转化效率尚未得到证实。它的出现限制了联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）的应用。将不可切除肿瘤转化为可切除肿瘤的方法正在探索中。我们整合了ALPPS、介入性肝癌治疗、靶向治疗、免疫治疗，并提出了一种名为AITI的新型转化治疗方法。
对重庆医科大学附属第一医院接受AITI转化治疗模式的患者进行回顾性分析。对于经医生评估认为可能可切除但未来肝残余量（FLR）不足的患者，选择ALPPS。在一期ALPPS之前或分期之间使用介入性肝癌治疗、靶向治疗和免疫治疗。5例患者接受了AITI转化治疗模式。3例患者在ALPPS的两个阶段之间接受了传统转化治疗并实现了满意的肝肥大，而2例患者在转化治疗后通过ALPPS实现了根治性切除。在所有患者中，一期手术前的平均残余体积为580±245 mL，二期手术前增加到701±295 mL。一期手术的平均持续时间为175.00±17.32分钟，失血量为210.00±124.50 mL。二期手术的平均持续时间为234.00±25.35分钟，失血量为400.00±70.71 mL。平均治疗持续时间为136.8±98.3天。
AITI转化治疗模式安全有效。这种方法可以为不可切除的患者提供更多实现根治性切除的机会。
