
2026-04-09
Ukwelashwa komdlavuza wesibindi e-China 2026 sekuguqukele enkathini eshayelwa ukunemba, kugxile ekwehliseni ukuphindaphinda kwangemva kokuhlinzwa ngokuhlukaniswa kwengozi kanye nokwelashwa okuhlanganisiwe. Umdlavuza wesibindi, ngokuyinhloko i-hepatocellular carcinoma (HCC), manje ilawulwa kusetshenziswa i-immunotherapy ethuthukisiwe, izidakamizwa ezihlosiwe, nokungenelela kwendawo okuklanyelwe izingozi zokuphinda umuntu ngamunye. Ukuvumelana kwakamuva kochwepheshe kwangowezi-2026 kugcizelela ukuhlonzwa kweziguli ezisengozini enkulu kusenesikhathi nokusebenzisa izindlela zokwelapha ezihlelekile ezifana nama-PD-1 inhibitors ahlanganiswe nama-anti-angiogenic agents ukuze kuthuthukiswe kakhulu amazinga okusinda.
Indawo ye umdlavuza wesibindi ukuphathwa eShayina kushintshe kakhulu ngo-2026. Iqhutshwa ucwaningo olunzulu lomtholampilo kanye nokukhululwa kwe-"2026 Expert Consensus on Postoperative Adjuvant Therapy for Hepatocellular Carcinoma," izinqubo zokwelapha manje sezenzelwe umuntu kakhulu. Ifilosofi eyinhloko isukile endleleni yokulinganisa konke yaya esu elisuselwe ekuhlukaniseni ubungozi okunembile.
Ngokomlando, amazinga okuphindeka ngemva kokuhlinzwa ayephakathi kuka-50% no-70%. Kodwa-ke, idatha entsha iphakamisa ukuthi ukuhlanganisa ukwelashwa kwesistimu nokungenelela kwendawo kunganciphisa kakhulu lezi zibalo. Imihlahlandlela yango-2026 iqokomisa izinhlobo ezimbili ezihlukene zokuphindaphinda: ukuphindeka kwangaphambi kwesikhathi (phakathi neminyaka emibili) kanye nokuvela sekwephuzile (ngemuva kweminyaka emibili). Ngayinye idinga indlela yokwelapha ehlukile.
Ukuphindaphinda kwangaphambi kwesikhathi kuvame ukuxhunyaniswa nama-micro-metastase akhona ngaphambi kokuhlinzwa noma ukusabalalisa ngokuhlinza. Ngokuphambene, ukuvela sekwephuzile ngokuvamile ibangelwa ama-de novo tumors avela ngenxa yesifo sesibindi esingamahlalakhona, njenge-hepatitis B noma i-cirrhosis. Ukuqaphela lo mehluko kubalulekile ekukhetheni i-adjuvant therapy efanele.
Odokotela manje basebenzisa indlela ethile yokuhlonza iziguli ezidinga ukwelashwa okunamandla ngokushesha ngemva kokuhlinzwa. Lezi zinto ezinobungozi obukhulu zihlanganisa:
Iziguli ezibonisa lezi zici zibhekwa njengabaqambi abayinhloko bokwelashwa okunamandla kwe-adjuvant, okuhlanganisa i-immunotherapy nama-ejenti ahlosiwe.
Ukuze kuphinde kwenzeke kamuva, kugxilwa ekulawuleni isifo sesibindi sangemuva. Abanikeli ababalulekile bahlanganisa:
Ukuphathwa kwaleli qembu kubeka phambili ukwelashwa kwe-antiviral yesikhathi eside kanye nokuqapha okuvamile ukuvimbela ukwakheka okusha kwesimila.
Esinye sezibuyekezo ezibaluleke kakhulu kuzinkombandlela zika-2026 ukuhlanganiswa okusemthethweni kwe-systemic antitumor therapy kusilungiselelo se-adjuvant. Lokhu kuphawula ukungena kwe umdlavuza wesibindi ukwelashwa ku "inkathi ehlosiwe-immunotherapy." Ngaphambilini, izidakamizwa ze-systemic bezigcinelwe amacala athuthukile, angenakuvinjelwa. Manje, zisetshenziswa ngokuqhubekayo ukuze kuqedwe izifo ezinsalela ze-microscopic.
Ukuhlolwa komtholampilo kwakamuva kubonise ukuthi ukuhlanganisa i-immune checkpoint inhibitors (ICIs) ne-tyrosine kinase inhibitors (TKIs) noma amasosha omzimba e-anti-VEGF kuveza imiphumela ephakeme uma kuqhathaniswa ne-monotherapy. Uhlobo lwe-“T+A” (i-Atezolizumab kanye ne-Bevacizumab) nezinhlanganisela zasekhaya ezifana ne-Donafenib kanye ne-Toripalimab kubonise imiphumela ethembisayo ekweluleni Ukusinda Okungabuyeli Ukuphila (RFS).
Ezigulini ezisengozini enkulu, i-immunotherapy ye-ejenti eyodwa enezidakamizwa ezifana ne-Sintilimab noma i-Nivolumab nayo ibonakale isebenza kahle. Lawa ma-ejenti asiza ukuvuselela amasosha omzimba ukuze abone futhi abhubhise amangqamuzana omdlavuza asele. Ukuvumelana kwango-2026 kuphawula ngokucacile ukuthi lezi zindlela zokwelapha azisahlolwa kodwa ziyizinketho ezinconyiwe ezijwayelekile zamaqembu afanelekile anobungozi obukhulu.
Idatha eyethulwe ezingqungqutheleni zamuva zemfundo e-Shanghai ikhombisa ukuthi inoveli ethile yezidakamizwa eziqondiswe ingafinyelela izinga le-RFS lonyaka owodwa elisondela ku-87% kubantu abasengozini enkulu. Ngaphezu kwalokho, inhlanganisela yemithi yeziguli ezinezimila ezinkulu (>5 cm) kanye ne-MVI zibike amazinga okusinda onyaka owodwa angaphezu kwama-96%. Lezi zibalo zimelela ushintsho olukhulu ukusuka kumabhentshimakhi omlando.
Nokho, ukusetshenziswa kwale mithi enamandla kudinga ukukhethwa ngokucophelela kwesiguli. Akuzona zonke iziguli ezizuza ngokulinganayo, futhi amandla okuba nezenzakalo ezimbi ezihlobene nokuzivikela komzimba (irAEs) adinga uhlaka oluqinile lokulawula ukuphepha.
Ngenkathi ukwelashwa kwe-systemic kuzuza ukuvelela, ukwelashwa kwasendaweni kuhlala kudingekile ku-algorithm yokwelapha yango-2026. Ukuvumelana okubuyekeziwe kunikeza imihlahlandlela ecwengisisiwe yokuthi isetshenziswa nini futhi kanjani i-Transarterial Chemoembolization (TACE), i-Hepatic Arterial Infusion Chemotherapy (HAIC), kanye ne-radiotherapy.
Ezigulini ezisengozini enkulu, i-adjuvant TACE iyanconywa cishe inyanga eyodwa ngemuva kokuhlinzwa. Iphrothokholi ejwayelekile ibandakanya isifundo esisodwa kuya kwezimbili. Lesi sikhathi sivumela isibindi ukuthi silulame ngemva kokuhlinzwa kuyilapho siqondise noma imaphi ama-metastases ayinsalela atholakala egazini. I-TACE isebenza ngokunqamula ukutholakala kwegazi kumaseli asele wesimila futhi ilethe ukugxila okuphezulu kwe-chemotherapy ngqo esibindini.
Okugqamile okukhulu kokuvuselelwa kwe-2026 yizincomo ezithile ze-HAIC zeziguli ezine-Microvascular Invasion (MVI). Isebenzisa uhlobo lwe-FOLFOX, i-HAIC iboniswe ukuthi ithuthukisa kakhulu i-RFS kuleli qembu elincane. Ngokungafani ne-TACE, ehlanganisa imithambo, i-HAIC iqhubeka ifaka ukwelashwa ngamakhemikhali, igcina amazinga aphezulu ezidakamizwa ezicutshini zesimila nemiphumela engemihle embalwa yesistimu.
Amamajini okuhlinzwa ayisibikezelo esibalulekile sokuphindaphinda. Ezigulini ezinamamajini amancane okukhishwa kabusha (≤1 cm), i-MVI enhle, noma i-portal vein tumor thrombus, I-Intensity-Modulated Radiation Therapy (IMRT) manje iyithuluzi eliyinhloko le-adjuvant. I-Radiotherapy ivala kahle umbhede wesimila, inciphisa ingozi yokuphindeka kwendawo. Kubaluleke kakhulu uma ukuhlinzwa okwengeziwe kungenzeki.
Ukuvumelana ngo-2026 kugcizelela ukuthi ukwelapha isimila kuyingxenye yempi; ukulawula isifo sesibindi esicashile kubalulekile ngokufanayo. Le ndlela “yokuphatha izifundo zonke” iqinisekisa ukuthi indawo yesibindi ayikukhuthazi ukukhula komdlavuza omusha.
Njengoba kunikezwe ukuthi iningi umdlavuza wesibindi amacala e-China ahlotshaniswa ne-Hepatitis B Virus (HBV), ukwelashwa kwe-antiviral impilo yonke akuxoxiswana ngakho. Iziqondiso zigunyaza ukusetshenziswa kwama-nucleos(t) ama-ide analogues anezithiyo eziphakeme zokumelana, njenge-Entecavir noma i-Tenofovir. Ukucindezela ukuphindaphinda kwegciwane akuvikeli kuphela ukusebenza kwesibindi kodwa futhi kunciphisa ngokuqondile ingozi yokuphindaphinda komdlavuza.
Ezigulini ze-Hepatitis C (HCV), ama-antiviral asebenza ngokuqondile (DAAs) ayanconywa, nakuba ubufakazi obengeziwe buyadingeka ukuze kuqinisekiswe umthelela wawo othize ekuvimbeleni ukuphindaphinda kwangemva kokuhlinzwa uma kuqhathaniswa nokwelashwa kwe-HBV.
Imithi edidiyelwe iyaqhubeka nokubamba iqhaza endaweni yokwelapha yaseChina. Ukuvumelana kuncoma i-Huaier Granule ezigulini ngemva kokuhlinzwa okukhulu. Ukubhekwa komtholampilo kusikisela ukuthi kungasiza ukuvimbela ukuphindeka futhi kwandise isikhathi sokuphila, kusebenze njengokwelashwa okusekelayo kanye nokwelashwa okuvamile.
Ngaphandle kokwelashwa okuqondile, indlela yokunquma ngohlelo lokwelapha nayo ithuthukisiwe. Inguqulo ka-2026 yohlelo lwesiteji lwe-Barcelona Clinic Liver Cancer (BCLC), olwamukelwa kabanzi e-China, manje luhlanganisa uhlaka olusha lokuthatha izinqumo olwaziwa nge-CUSE.
I-CUSE imele ukuthi Inkimbinkimbi, Ukungaqiniseki, Ukuzithoba, kanye Nemizwa. Lolu hlaka luqondisa amaqembu ezinhlaka eziningi ukuthi acabangele izilinganiso ezine ezibalulekile:
Ngokuhlanganisa lezi zici zomuntu nobufakazi bomtholampilo, uhlaka lwe-CUSE luqinisekisa ukuthi izinqumo zokwelashwa zigxile esigulini ngempela, zihamba ngaphezu kwe-algorithms eqinile kuya ezinhlelweni zokunakekelwa komuntu siqu.
Isibuyekezo sika-2026 BCLC sethula izinguquko ezithile ezithile:
Ukusiza iziguli nemindeni ukuthi iqonde izinketho, ithebula elilandelayo liqhathanisa izindlela zokwelapha eziyisisekelo ezinconywe ngo-2026.
| Indlela Yokwelapha | Izimpawu Ezisemqoka | I-Ideal Application Scenario |
|---|---|---|
| Ama-Immune Checkpoint Inhibitors (ICI) | Ivuselela amasosha omzimba; amandla okuphendula okuhlala isikhathi eside; ingozi yezenzakalo ezimbi ezihlobene nokuzivikela komzimba. | Iziguli ezisengozini enkulu enezici zokuphinda ziphinde zibuye; ngokuvamile kuhlanganiswe nama-TKI. |
| I-Tyrosine Kinase Inhibitors (TKI) | Iqondise i-angiogenesis nezindlela zokukhula kwesimila; ukuphathwa ngomlomo; imiphumela emibi elawulekayo. | Ukulungiselelwa kwe-Adjuvant kwamaqembu asengozini enkulu; ukwelashwa kwesondlo. |
| I-Transarterial Chemoembolization (TACE) | Ukulethwa kwendawo kwe-chemo + embolization; ukuhlasela kancane; idinga ukufinyelela kwe-arterial. | Iziguli ezisengozini enkulu ngemva kokuhlinzwa; ngokuvamile izifundo ezingu-1-2 phakathi nenyanga eyodwa. |
| I-Hepatic Arterial Infusion (HAIC) | Ukumnika okuqhubekayo kwe-chemo ephezulu; ubuthi obuphansi besistimu; ngempumelelo ukuhlasela kwemithambo. | Iziguli ezine-Microvascular Invasion (MVI); Kukhethwa uhlobo lwemithi ye-FOLFOX. |
| I-Radiotherapy (IMRT/SBRT) | Ukuqondisa ngemisebe okunembile; okungahlaseli; ngempumelelo ekulawuleni kwendawo. | Imikhawulo emincane yokuhlinzwa (≤1 cm); i-portal vein tumor thrombus. |
Ukuzulazula ohambweni lwangemva kokusebenza kungaba nzima. Ngokusekelwe ekuvumelaneni kwakamuva, nansi indlela eqondile yeziguli ezibhekene nayo umdlavuza wesibindi ukwelashwa eChina.
Ukufinyelela ekwelashweni okusezingeni eliphezulu kuyinto ekhathaza kakhulu iziguli. Ngo-2026, isimo sezezimali se umdlavuza wesibindi ukwelashwa e-China kube ngcono kakhulu ngenxa yezinguquko zomshwalense kazwelonke.
Ukuthuthukiswa okubalulekile ukufakwa kwama-PD-1 inhibitors amaningana athuthukiswe ekhaya ku-National Reimbursement Drug List (NRDL). Izidakamizwa ezinjengoFinolimab nezinye zibone izinkomba zazo zanda ukuze zimboze umdlavuza wesibindi, okwenza ukuthi zithengeke esigulini esijwayelekile. Lesi sinyathelo sehlise kakhulu izindleko eziphuma ephaketheni ze-immunotherapy, phambilini ebimba eqolo.
Ukwengeza, izindlela zokwelapha ezihlosiwe kanye nezinqubo ezithile zokungenelela zendawo zihlanganiswa ngaphansi kwezikimu zomshwalense wezokwelapha eziyisisekelo. Isilinganiso esiqondile sembuyiselo siyahlukahluka ngesifunda kanye nohlobo oluthile lomshwalense, kodwa ukuthambekela kubheke ekukhavweni okubanzi kwezindlela zokwelapha ezisha ezifakazelwe ukuthi zandisa ukuphila.
Nakuba izindleko ezithile zihluka ngesibhedlela nesifunda, iziguli kufanele zilindele izindleko ezihlobene nalokhu:
Iziguli zelulekwa ukuthi zithintane nosonhlalakahle basesibhedlela noma abaxhumanisi bomshuwalense ukuze kwandiswe izinzuzo zazo. Izibhedlela eziningi ezisezingeni eliphezulu emadolobheni afana neShanghai neBeijing zineminyango ezinikele ukusiza ngezicelo zomshwalense nezinhlelo zosizo.
Ukukhetha isikhungo sezokwelapha esifanele kubalulekile ukuze kube nemiphumela emihle. I-China inezikhungo ezimbalwa ezisezingeni lomhlaba ezisebenza nge-hepatobiliary oncology. I-"China Innovation Alliance for Hepato-Biliary Cancer," eyethulwe muva nje, ixhumanisa izikhungo zezokwelapha eziphezulu ezingaphezu kuka-20 ukuze zilinganise ukunakekelwa nokukhuthaza ucwaningo.
Izibhedlela eziningi zidume ngobungcweti bazo bokusebenzisa imihlahlandlela yokuvumelana yango-2026:
Lapho zifuna ukwelashwa, iziguli kufanele ziqinisekise uma isibhedlela sinikeza:
Yize intuthuko ngo-2026 iyathembisa, kubalulekile ukukala izinzuzo ngokubhekana nezihibe ezingaba khona.
Inkambu ye umdlavuza wesibindi Ukwelashwa kunamandla. Uma ubheka ngale kuka-2026, izindawo ezimbalwa zilungele ukuqhubeka nokuthuthuka. Ukusungulwa kwemininingwane kazwelonke ngemifelandawonye efana ne-China Innovation Alliance for Hepato-Biliary Cancer kuzosheshisa ukutholwa okuqhutshwa idatha.
I-Artificial Intelligence iya ngokuya isetshenziswa ukubikezela izingozi eziphindelelayo kanye nokuthuthukisa izinhlelo zokwelashwa. Amapulatifomu edijithali asiza ukuqapha okukude, okuvumela iziguli ukuthi zibike izimpawu ngesikhathi sangempela, okusiza ekutholeni kusenesikhathi izehlakalo ezimbi. Itimu ethi "inombolo yokunika amandla ubuhlakani" egqanyiswe emihlanganweni yakamuva yaminyaka yonke yezemfundo ibonisa lolu shintsho olubheke ekunakekelweni okunikwe amandla ezobuchwepheshe.
Ucwaningo luyaqhubeka kokuhlosiwe okusha ngale kwe-axis yamanje ye-PD-1/VEGF. Amasosha omzimba e-Bispecific, imishanguzo yeseli ye-CAR-T eklanyelwe izimila eziqinile, nemithi yokugomela yokwelapha isezigabeni ezihlukahlukene zokuthuthuka komtholampilo. Umgomo uwukuguqula izimila "ezibandayo" zibe "ezishisayo" ezisabela kakhulu ku-immunotherapy.
Abacwaningi baseShayina basebenza ngokubambisana nabalingani bamazwe ngamazwe. Ucwaningo lwezikhungo eziningi ezibandakanya izikhungo ezivela emazweni amaningi seluvamile, luqinisekisa ukuthi izindinganiso zokwelashwa e-China zihambisana nezinqubo ezihamba phambili zomhlaba kuyilapho kubhekwa izici ezihlukile zendawo zesifo esiwumshayabhuqe, njengokuvama okuphezulu kwe-HBV.
Unyaka wezi-2026 uphawula inkathi yenguquko umdlavuza wesibindi ukwelashwa eChina. Ngokukhululwa kokuvumelana kochwepheshe okubuyekeziwe kanye nokuhlanganiswa kwezinhlelo zesiteji ezithuthukisiwe, iziguli manje sezikwazi ukufinyelela kumasu okunakekela anembe, asebenzayo, naqondene nomuntu. Ukushintshela ekuhlanganiseni i-systemic immunotherapy nokungenelela kwendawo kunikeza ithemba elivuselelwe lokunciphisa amanani aphezulu okuphinda kwenzeke ngemva kokuhlinzwa.
Okubalulekile kule nqubekelaphambili ukugcizelela ekuhlukaniseni ubungozi, ukuqinisekisa ukuthi iziguli ezisengcupheni enkulu zithola ukwelashwa okunolaka kuyilapho iziguli ezisengozini encane zigwema ubuthi obungadingekile. Ngokuhambisana nokulawulwa okuqinile kwe-antiviral kanye nokuhlinzekwa komshwalense okuthuthukisiwe, umbono weziguli ezinomdlavuza wesibindi ukhanya kakhulu kunangaphambili. Ngokusebenzisa ubuchwepheshe bezikhungo zezokwelapha ezisezingeni eliphezulu nokuthobela imihlahlandlela yakamuva, iziguli zingazulazula ohambweni lwazo lokwelashwa ngokuzethemba nethemba.
Njengoba ucwaningo luqhubeka nokuvela futhi kuvela nobuchwepheshe obusha, ukusebenzisana phakathi kwabelaphi, abacwaningi, kanye neziguli kuzohlala kuyimbangela yentuthuko eyengeziwe yokuphila kanye nezinga lempilo. Kunoma ubani othintekayo umdlavuza wesibindi, ukuhlala unolwazi ngalezi zenzakalo zakamuva nokufuna ukunakekelwa ezikhungweni ezikhethekile kuyisinyathelo esibaluleke kakhulu esiholela kumphumela oyimpumelelo.