
2026-04-09 - dr hab
Mob qog noj ntshav siab ciaj sia nyob rau hauv 2026 tau pom kev txhim kho tseem ceeb vim kev ua txhaum ntawm kev kho neoadjuvant thiab kho cov txheej txheem kho mob los ntawm Tuam Tshoj. Cov kev tshawb fawb tsis ntev los no qhia tau hais tias kev sib xyaw tshuaj tshiab ua ntej kev phais tuaj yeem yuav luag ob npaug ntawm lub sijhawm cov neeg mob nyob yam tsis muaj kab mob rov qab, hloov pauv tus qauv kev saib xyuas thoob ntiaj teb.
Cov toj roob hauv pes ntawm hepatocellular carcinoma (HCC) thiab kev kho mob intrahepatic cholangiocarcinoma (ICC) tau hloov pauv sai heev nyob rau thaum ntxov 2026. Tau ntau xyoo lawm, mob qog noj ntshav tau cuam tshuam nrog cov tsos mob tsis zoo thiab qhov rov muaj dua. Txawm li cas los xij, mob qog noj ntshav muaj sia nyob Cov kev ntsuas tam sim no tau raug rov txhais los ntawm kev sim tshuaj nruj me ntsis los ntawm cov chaw kho mob loj hauv Suav.
Ib qho kev tshawb nrhiav tseem ceeb tshaj tawm hauv lub New England Journal of Medicine nyob rau lub Peb Hlis 2026 qhia txog kev hloov pauv. Thawj coj los ntawm cov kws tshawb fawb ntawm Fudan University's Zhongshan Tsev Kho Mob, qhov kev sim ntau lub hauv paus tau pom tias cov txheej txheem neoadjuvant tshwj xeeb tuaj yeem txuas ntxiv qhov xwm txheej tsis pub muaj sia nyob los ntawm 8.7 lub hlis mus rau 18 lub hlis. Qhov no sawv cev ze li ob npaug ntawm lub sijhawm cov neeg mob nyob twj ywm tsis muaj mob qog noj ntshav tom qab kho.
Qhov tseem ceeb ntawm cov ntaub ntawv no tsis tuaj yeem overstated. Keeb kwm, qhov muaj sia nyob tsib xyoos tom qab kev phais mob rau qee cov qog nqaij hlav hauv siab hovered ntawm 25% thiab 40%. Kev sib koom ua ke ntawm cov phiaj xwm kev kho mob thiab kev tiv thaiv kab mob ua ntej kev phais yog sai dhau los ua "tus qauv ntawm kev saib xyuas" tshiab rau cov neeg mob tsim nyog. Txoj hauv kev no txo qis cov qog nqaij hlav ua ntej riam puas tau kov ntawm daim tawv nqaij, nrog lub hom phiaj cov lus teb nce mus txog kwv yees li 55% hauv cov pab pawg sim.
Cov kev nce qib no tsis txwv rau qhov chaw sim. Thaum Lub Ib Hlis 2026, National Health Commission ntawm Tuam Tshoj tau tshaj tawm Kev Tshawb Nrhiav thiab Kev Kho Mob Ntshav Siab (Primary Liver Cancer Diagnosis and Treatment Guidelines) (2026 Edition). Cov ntaub ntawv no suav nrog cov ntaub ntawv pov thawj zoo, suav nrog kev tshawb fawb hauv tebchaws tau luam tawm nyob rau hauv cov ntawv xov xwm thoob ntiaj teb, muab cov lus qhia muaj cai rau kev kho mob thoob plaws tebchaws.
Qhov kev tso tawm ntawm 2026 cov lus qhia yog qhov tseem ceeb hauv kev tawm tsam thoob ntiaj teb tiv thaiv kab mob qog noj ntshav. Tsis zoo li yav dhau los iterations, 2026 version qhia meej nrog cov kev tshawb pom tshiab los ntawm "cov phiaj xwm ntxiv tiv thaiv" era. Nws txav mus dhau qhov yooj yim anatomical staging kom suav nrog cov kev pheej hmoo lom neeg, kom ntseeg tau tias kev kho mob raug kho raws li tus neeg mob qhov tshwm sim ntawm kev rov tshwm sim.
Cov ntaub ntawv sib koom, lub Cov kws tshaj lij pom zoo rau Kev Kho Mob Tom Qab Kev Kho Mob rau Hepatocellular Carcinoma (2026 Edition), kuj tau nthuav tawm hauv Shanghai. Spearheaded los ntawm cov kws tshawb fawb Fan Jia thiab Zhou Jian, qhov kev pom zoo no hais txog qhov teeb meem tawv ncauj ntawm kev rov ua dua tom qab phais, uas cuam tshuam txog 50% txog 70% ntawm cov neeg mob. Qhov kev pom zoo muab cov qauv txheej txheem los txheeb xyuas cov neeg mob "qhov nruab nrab-rau-siab" uas tau txais txiaj ntsig zoo tshaj plaws los ntawm kev kho mob ntxiv.
2026 kev pom zoo qhia txog txoj hauv kev zoo rau kev faib cov kev pheej hmoo rov tshwm sim. Qhov stratification no yog qhov tseem ceeb rau kev txiav txim siab seb tus neeg mob puas xav tau kev kho mob hnyav lossis tuaj yeem tswj tau nrog kev saib xyuas niaj hnub.
Qhov kev ntsuas qhov tseeb no mus rau "qhov nruab nrab-rau-siab txaus ntshai" pab pawg ua kom ntseeg tau tias cov kev kho mob muaj zog tau tshwj tseg rau cov neeg xav tau tshaj plaws, ua kom zoo dua cov peev txheej faib thiab txo qis cov kev mob tshwm sim tsis tsim nyog rau cov tib neeg muaj kev pheej hmoo tsawg. Cov lus qhia tau hais tias kev kho mob qog noj ntshav tau nkag mus rau theem tshiab uas nws qhov hnyav hauv qhov chaw kho mob tau nce ntxiv.
Lub tswv yim ntawm kev kho neoadjuvant - kho mob qog noj ntshav ua ntej qhov kev phais thawj zaug - tau kawm tiav los ntawm kev sim mus rau qhov tseem ceeb hauv xyoo 2026. Qhov kev sim ua rau muaj 178 tus neeg mob thoob plaws 11 lub tsev kho mob hauv Suav teb tau muab cov pov thawj muaj zog uas xav tau los txhim kho txoj hauv kev no.
Hauv qhov kev sim no, ib pab pawg tau txais peb lub voj voog ntawm Gemox chemotherapy ua ke nrog cov tshuaj kho mob thiab tus neeg sawv cev tiv thaiv kab mob. Pawg tswj hwm tau raug phais tam sim ntawd, uas yog tus qauv ib txwm muaj. Cov txiaj ntsig tau zoo heev: qhov nruab nrab qhov xwm txheej tsis muaj sia nyob rau pawg tshuaj sib xyaw yog 18 lub hlis, piv rau tsuas yog 8.7 lub hlis rau pawg phais nkaus xwb.
Qhov kev vam meej ntawm no cocktail nyob rau hauv nws multi-pronged nres ntawm cov qog. Kev kho mob ncaj qha tua cov cell faib sai. Targeted therapy tshuaj inhibit txoj kev tshwj xeeb uas ua rau cov qog nqaij hlav loj hlob thiab angiogenesis (kev tsim cov hlab ntsha). Cov tshuaj tiv thaiv kab mob, xws li PD-1 inhibitors, pab lub cev lub cev tiv thaiv kab mob paub txog thiab tua cov qog nqaij hlav cancer uas yuav tsis pom kev.
Los ntawm kev txo cov qog ua ntej kev phais, cov kws phais tuaj yeem ua tiav cov npoo kom pom tseeb (R0 resection), uas yog qhov tseem ceeb ntawm kev muaj sia nyob mus ntev. Tsis tas li ntawd, kev kho mob micrometastases ntxov tiv thaiv lawv los ntawm kev tsim cov footholds hauv lwm qhov ntawm daim siab lossis lub cev thaum lub sijhawm phais mob.
Txoj haujlwm no tam sim no tau txais los ntawm cov tsev kho mob thawj coj tsis yog hauv Suav teb nkaus xwb tab sis cuam tshuam rau cov txheej txheem thoob ntiaj teb. Lub peev xwm los hloov cov xwm txheej uas tsis tuaj yeem hloov pauv mus rau cov uas tuaj yeem hloov tau los ntawm kev txo qis yog qhov muaj txiaj ntsig tshwj xeeb rau cov neeg mob uas muaj qog nqaij hlav loj lossis nyuaj.
Txawm tias tom qab ua tiav kev phais, qhov kev pheej hmoo ntawm kev rov tshwm sim tseem yog lub hauv paus tseem ceeb rau lub sijhawm ntev mob qog noj ntshav muaj sia nyob. 2026 Cov Kws Tshaj Lij Pom Zoo muab cov lus qhia ntxaws ntxaws rau kev kho mob ntxiv, txav deb ntawm "ib qhov loj-haum-tag nrho" mus rau qhov tseeb tshuaj.
Qhov kev pom zoo qhia txog kev nkag mus rau kev kho mob rau hauv "lub hom phiaj-immune era." Cov ntaub ntawv los ntawm kev tshawb fawb txog sintilimab thiab atezolizumab ntxiv rau bevacizumab ("T + A" kev tswj hwm) tau nce qhov hnyav ntawm kev kho mob hauv lub sijhawm adjuvant.
Tshwj xeeb tshaj yog, donafenib monotherapy rau cov neeg mob uas muaj kev pheej hmoo siab tau pom tias 1-xyoo rov qab tsis tau muaj sia nyob nce mus txog 87%. Hauv cov neeg mob tshwj xeeb, kev sib xyaw ua ke tau thawb 1-xyoo kev muaj sia nyob tag nrho rau 96.7%. Cov duab no sawv cev ib qho monumental leap los ntawm cov ntaub ntawv keeb kwm.
Tshaj li cov tshuaj siv tshuaj, cov kev kho mob hauv zos ua lub luag haujlwm tseem ceeb hauv kev tshem tawm cov kab mob seem. 2026 cov txheej txheem sib sau ua ke thiab kho cov lus qhia rau Transarterial Chemoembolization (TACE), Hepatic Arterial Infusion Chemotherapy (HAIC), thiab kev kho hluav taws xob.
Cov kev cuam tshuam hauv cheeb tsam no yog tsim los rau lub hom phiaj ntawm lub siab lub txaj uas qhov rov tshwm sim feem ntau yuav tshwm sim, ua raws li kev ruaj ntseg network nrog rau kev kho mob.
Barcelona Clinic Liver Cancer (BCLC) staging system tseem yog qhov siv ntau tshaj plaws thoob ntiaj teb. Qhov hloov tshiab xyoo 2026 tswj hwm nws qhov tseem ceeb ntawm kev ua haujlwm, kev soj ntsuam, thiab kev kho mob tab sis qhia txog kev txiav txim siab hloov pauv txheej txheem: CUSE lub hauv paus.
Qhov hloov tshiab 2026 BCLC suav nrog Complexity, Uncertainty, Subjectivity, thiab Emotion (CUSE) rau hauv kev txiav txim siab kho mob. Qhov no lees paub tias kev kho mob qog noj ntshav tsis yog ua raws li cov txheej txheem raws li cov qog loj; nws koom nrog navigating lub vev xaib nyuaj ntawm cov neeg mob tshwj xeeb.
Lub moj khaum no qhia Cov Pab Pawg Sib Koom Tes (MDT) kom txiav txim siab ntau yam txuj ci, tus neeg mob nyob hauv nruab nrab. Nws ua kom ntseeg tau tias qhov kev kho mob "zoo tshaj" ntawm daim ntawv sib haum nrog qhov tseeb ntawm tus neeg mob lub neej, qhov tseem ceeb, thiab lub cev khaws cia.
| BCLC Theem | 2026 Hloov tshiab Highlights | Cov Kev Kho Mob Tseem Ceeb |
|---|---|---|
| Theem 0 / A (Thaum ntxov / ntxov) | Ntxiv ntawm Stereotactic Lub Cev Radiation Therapy (SBRT) thiab Transarterial Radioembolization (TARE) raws li kev xaiv kho. | Kev phais, Ablation, SBRT, TARE |
| Qib B (Intermediate) | Cov ntaub ntawv pov thawj tam sim no tsis txaus los txhawb kev sib koom ua ke ntawm kev cuam tshuam kev kho mob thiab kev kho mob. | TACE, HAIC, Systemic Therapy (cov neeg raug xaiv) |
| Qib C (Advanced) | Consolidates immuno-combination regimens raws li thawj kab txheej txheem ntawm kev saib xyuas. | Immune Checkpoint Inhibitors + TKIs / Antibodies |
| Theem D (Terminal) | Tsom ntsoov rau kev txhawb nqa zoo tshaj plaws thiab kev tswj cov tsos mob. | Palliative Care |
Kev suav nrog SBRT thiab TARE ua lwm txoj hauv kev kho mob rau cov neeg mob thaum ntxov nthuav dav lub thawv rau cov neeg uas tsis yog cov neeg sib tw rau kev phais lossis ablation vim qhov chaw qog nqaij hlav lossis comorbidities. Lub caij no, kev ceeb toom hais txog kev kho ua ke niaj hnub hauv theem B qhia txog kev cog lus rau kev coj ua pov thawj, tsis txhob muaj kev kho mob ntau dhau mus txog thaum muaj ntaub ntawv ntau ntxiv.
Qhov kev pom zoo xyoo 2026 tseem hais txog cov xwm txheej tshwj xeeb uas feem ntau cuam tshuam rau kev tswj mob qog noj ntshav hauv siab, tshwj xeeb yog kev hloov lub siab thiab kho ablation.
Rau cov neeg mob uas tau hloov lub siab, kev xaiv ntawm kev tiv thaiv kab mob yog qhov tseem ceeb. Qhov kev pom zoo pom zoo siv mTOR inhibitors (xws li sirolimus lossis everolimus) ua cov pob txha ntawm kev tiv thaiv kab mob. Tsis zoo li calcineurin inhibitors, mTOR inhibitors tau pom tias muaj cov khoom tiv thaiv qog, uas tuaj yeem pab txo qis kev pheej hmoo ntawm mob qog noj ntshav tom qab hloov pauv.
Thaum cov pov thawj qib siab rau kev kho mob tshwj xeeb tom qab ablation tseem tsub zuj zuj, qhov kev pom zoo sau tseg tias cov tshuaj tiv thaiv lossis tshuaj tiv thaiv kab mob yuav raug txiav txim siab rau cov neeg mob uas muaj kev pheej hmoo siab ablation. Muab hais tias ablation feem ntau yog siv rau cov qog me me, qhov kev pheej hmoo profile txawv ntawm qhov loj me me, tab sis lub hauv paus ntsiab lus ntawm kev hais txog tus kab mob micrometastatic tseem cuam tshuam rau cov uas muaj cov yam ntxwv tsis zoo.
Ib qho tseem ceeb, feem ntau overlooked nam ntawm kev txhim kho mob qog noj ntshav muaj sia nyob yog kev tswj cov kab mob siab hauv qab. 2026 cov lus qhia hais txog kev kho mob rau lub siab keeb kwm yav dhau yog qhov tseem ceeb rau txhua tus neeg mob.
Rau cov neeg mob uas muaj tus kab mob siab B (HBV) ntsig txog mob qog noj ntshav, kev siv cov nucleoside analogs mus tas li (xws li tenofovir lossis entecavir) yog qhov yuav tsum tau ua tom qab phais. Tiv thaiv tus kab mob replication txo o, tiv thaiv daim siab decompensation, thiab txo qhov kev pheej hmoo ntawm de novo carcinogenesis nyob rau hauv cov ntaub so ntswg daim siab.
Hauv kev sib koom ua ke tseem ceeb ntawm cov tshuaj niaj hnub thiab niaj hnub, kev pom zoo pom zoo kom siv Huaier granules tom qab kev phais radical. Cov kev soj ntsuam soj ntsuam qhia tias qhov kev npaj tshuaj suav niaj hnub no tuaj yeem pab tiv thaiv kev rov qab los thiab txuas ntxiv kev muaj sia nyob, muab cov txheej txheem ntxiv ntawm kev tiv thaiv rau cov neeg mob rov zoo.
Cov tswv yim taug qab tau raug hloov kho dua tshiab, tshwj xeeb tshaj yog rau cov pab pawg muaj kev pheej hmoo nruab nrab mus rau siab. Qhov kev pom zoo yog rau kev soj ntsuam tsawg kawg txhua peb lub hlis. Tshaj li cov duab pom zoo (CT lossis MRI), cov lus qhia qhia tias qhov twg tso cai, cov cuab yeej ua kua biopsy xws li Circulating Tumor Cells (CTC) thiab cov qog DNA (ctDNA) yuav tsum tau siv.
Kev nkag mus rau kev saib xyuas tshwj xeeb yog qhov tseem ceeb hauv kev muaj sia nyob. Cov neeg mob nrhiav cov txheej txheem tshiab, suav nrog cov kev tswj hwm neoadjuvant thiab cov kev kho mob hauv zos tau piav qhia saum toj no, yuav tsum nrhiav cov chaw uas muaj kev mob siab rau hepatobiliary oncology departments.
Hauv Suav teb, cov koom haum xws li Fudan University's Zhongshan Tsev Kho Mob, Tsev Kho Mob Cancer ntawm Suav Academy ntawm Kev Tshawb Fawb Txog Kev Kho Mob, thiab Thawj Tsev Kho Mob ntawm USTC yog tus thawj coj hauv kev ua raws li 2026 cov lus qhia. Thoob ntiaj teb, cov neeg mob yuav tsum nrhiav NCI-tsim cov chaw kho mob qog noj ntshav lossis tsev kho mob hauv tsev kawm qib siab nrog cov kev pabcuam hepatobiliary.
Txawm hais tias kev nce qib kev kho mob hauv 2026 tau cog lus tseg, tus nqi tseem yog qhov kev txhawj xeeb tseem ceeb rau ntau tus neeg mob. Kev hloov mus rau kev sib xyaw ua ke ntawm immunotherapy thiab kev kho cov phiaj xwm tuaj yeem ua rau muaj kev cuam tshuam nyiaj txiag ntawm kev kho mob.
Hauv Suav teb, ntau cov tshuaj tau pom zoo, suav nrog cov tshuaj hauv tsev PD-1 inhibitors thiab TKIs, tau suav nrog hauv cov ntawv pov hwm kho mob hauv tebchaws, txo cov nqi tawm hauv hnab tshos rau cov neeg mob. Txoj cai tswjfwm no yog qhov tseem ceeb hauv kev ua kom ntseeg tau tias "kev daws teebmeem hauv tebchaws" rau kev tiv thaiv kab mob qog noj ntshav thiab kev tswj hwm tau nkag mus rau cov pej xeem dav.
Thoob plaws ntiaj teb, kev pab them nqi sib txawv raws lub teb chaws thiab cov kws kho mob. Cov neeg mob raug txhawb kom:
Nws yog ib qho tseem ceeb los saib cov nqi kho mob hauv cov ntsiab lus ntawm kev muaj sia nyob mus ntev. Cov kev kho neoadjuvant thiab adjuvant zoo uas tiv thaiv kev rov tshwm sim tuaj yeem txo tag nrho cov nqi ntawm kev saib xyuas los ntawm kev zam kom tsis txhob muaj kev kho mob kim, rov mus pw hauv tsev kho mob, thiab kev kho mob palliative cuam tshuam nrog kev mob hnyav, rov tshwm sim dua.
Kev kho mob ntawm daim siab mob cancer yog hloov zuj zus ntawm qhov tsis tau muaj dua. 2026 cov lus qhia yog ib qho kev paub txog tam sim no, tab sis kev tshawb fawb txuas ntxiv thawb ciam teb. Tsis ntev los no cov ntawv xa mus rau 2026 ASCO Lub Rooj Sib Tham Txhua Xyoo los ntawm cov tsev kho mob zoo li Zhongnan Tsev Kho Mob hais txog cov kev tawm tsam yav tom ntej.
Cov kev tsim kho tshiab no qhia tias lub ntsiab lus ntawm mob qog noj ntshav muaj sia nyob yuav txhim kho txuas ntxiv mus. Kev sib koom ua ke ntawm metabolic reprogramming kev pom thiab cov txheej txheem hluav taws xob txuas ntxiv tau cog lus tias yuav daws tau txawm tias cov kab mob tiv taus tshaj plaws.
Xyoo 2026 yog ib qho kev hloov pauv hauv kev sib ntaus sib tua tiv thaiv mob qog noj ntshav. Nrog rau kev tshaj tawm cov lus qhia tshiab hauv tebchaws, kev siv tau ntawm cov kev kho mob neoadjuvant, thiab kev kho kom zoo ntawm cov qauv kev pheej hmoo stratification, cov neeg mob niaj hnub no muaj kev xaiv zoo dua li yav dhau los. Qhov ze-ob npaug ntawm kev muaj sia nyob tsis pub muaj sia nyob hauv kev sim siab tsis ntev los no muab kev cia siab pom tau qhov twg muaj sijhawm tsawg.
Los ntawm daim ntawv thov meej ntawm "cov phiaj xwm ntxiv rau kev tiv thaiv kab mob" mus rau kev tswj hwm ntawm cov kab mob hauv lub siab, txoj hauv kev rau pem hauv ntej yog qhov tseeb. Kev vam meej nyob ntawm kev tshawb pom ntxov, kev nkag mus rau kev saib xyuas tshwj xeeb hauv ntau qhov kev qhuab qhia, thiab ua raws li cov ntaub ntawv pov thawj tseeb. Raws li kev tshawb fawb txuas ntxiv mus daws qhov nyuaj ntawm daim siab mob qog noj ntshav, txoj hauv kev rau mob qog noj ntshav muaj sia nyob cov ntsiab lus tsis tu ncua nce siab, hloov kho ib zaug kev kuaj mob tuag rau hauv kev tswj tau, thiab feem ntau kho tau, mob.
Cov neeg mob thiab tsev neeg raug txhawb kom koom tes nrog lawv pab pawg kho mob, nug txog cov lus qhia tshiab, thiab tshawb nrhiav txhua txoj hauv kev kho mob. Kev sib koom ua ke ntawm Suav cov kws tshaj lij kho mob thiab kev sib koom tes thoob ntiaj teb kev tshawb fawb tau tsim lub hauv paus muaj zog rau kev kov yeej mob qog noj ntshav, ib tus neeg mob ib zaug.