肝细胞癌(HCC)的低切除率和高复发率是改善预后的主要挑战。新辅助和转化疗法是克服这些挑战的潜在策略。迄今为止,目前尚无关于HCC新辅助和转换治疗的指南或共识。最近的研究表明,新辅助治疗可切除的HCC和转换治疗不可切除的HCC是安全的,可行,而且有效。新辅助和转化疗法在治疗HCC方面具有以下优势:R0切除具有足够体积的未来肝脏残留物,操作相对简单,和广泛的适用性。因此,在使用新辅助和转换疗法治疗HCC方面具有广泛专业知识和经验的中国专家之间有必要进行广泛接受的共识,这对于规范新辅助和转换治疗在HCC管理中的应用非常重要。新辅助治疗的策略包括选择符合条件的患者,治疗方案,周期,效果评估,多学科治疗。未来肝残量不足的患者和不能实现R0切除的患者的管理是转化治疗策略的关键。这里,我们提出了基于证据和经验的共识,以指导新辅助和转化疗法在临床实践中的应用.
The low resection and high recurrence rates in hepatocellular carcinoma (HCC) are the major challenges to improving prognosis. Neoadjuvant and conversion therapies are underlying strategies to overcome these challenges. To date, no
guideline or
consensus has been published on the neoadjuvant and conversion therapies in HCC. Recent studies showed that neoadjuvant therapy for resectable HCC and conversion therapy for unresectable HCC are safe, feasible, and effective. Neoadjuvant and conversion therapies have the following advantages in treating HCC: R0 resection with sufficient volume of future liver remnant, relatively simple operation, and wide applicability. Therefore, it was necessary to conduct a widely accepted
consensus among the experts in China who have extensive expertise and experience in treating HCC using neoadjuvant and conversion therapies, which is important to standardize the application of neoadjuvant and conversion therapies for the management of HCC. The strategies of neoadjuvant therapy include the selection of the eligible patients, therapy regimen, cycles, effect evaluations, and multidisciplinary treatment. The management of patients with insufficient volume of future liver remnant and patients who cannot achieve R0 resection is the key to the strategies of conversion therapy. Here, we present the resultant evidence- and experience-based
consensus to guide the application of neoadjuvant and conversion therapies in clinical practice.