钇-90微球在肝细胞癌转化治疗中的应用

Application of yttrium-90 microsphere in conversion therapy for hepatocellular carcinoma

摘要:

肝细胞癌（以下简称肝癌）是我国发病率和病死率均较高的恶性肿瘤之一，约64%的患者在初诊时已处于中晚期（CNLC Ⅱb期、Ⅲa期和Ⅲb期），多数已失去根治性治疗机会。转化治疗旨在通过有效干预，使原本不可切除的肝癌患者获得手术切除或肝移植的机会，从而改善长期预后。钇-90微球选择性内放射治疗（⁹⁰Y-SIRT）凭借其显著的局部控瘤能力、诱导剩余肝脏增生、促进门静脉癌栓消退以及较好的安全性和生活质量保障，在肝癌转化治疗中展现出独特优势。本文围绕⁹⁰Y-SIRT在肝切除和肝移植前转化治疗中的应用，系统梳理其作用机制、临床研究证据及联合治疗策略，并讨论当前面临的挑战与未来发展方向，以期为肝癌转化治疗的临床决策与研究提供参考。

Abstract:

Hepatocellular carcinoma (HCC) is one of the malignancies with high incidence and mortality rates in China. Approximately 64% of patients are diagnosed at intermediate or advanced stages at initial presentation (CNLC stages IIb, IIIa, and IIIb), and most have already lost the opportunity for curative treatment. Conversion therapy aims to enable initially unresectable HCC patients to become eligible for surgical resection or liver transplantation through effective interventions, thereby improving long-term outcomes. Yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT) has demonstrated unique advantages in HCC conversion therapy, owing to its potent local tumor control, induction of future liver remnant hypertrophy, promotion of portal vein tumor thrombus regression, and favorable safety profile with preservation of quality of life. This article systematically reviews the application of ⁹⁰Y-SIRT in conversion therapy prior to liver resection and liver transplantation, summarizes its mechanisms of action, clinical evidence, and combination treatment strategies, and discusses current challenges and future directions, with the aim of providing references for clinical decision-making and research in HCC conversion therapy.