The management of CSPH in patients undergoing systemic treatment for HCC has emerged as a critical concern due to the absence of reliable diagnostic criteria and uncertainties surrounding therapeutic approaches. This review aims to underscore the primary pathophysiological aspects linking HCC and PH, while also addressing the current and emerging clinical strategies for the management of portal hypertension. A review of studies from January 2003 to June 2023 was conducted using the PubMed database and employing MeSH terms, such as “hepatocellular carcinoma”, “immune checkpoint inhibitors”, “systemic therapy”, “portal hypertension”, “variceal bleeding” and “tyrosine kinase inhibitors”. Despite promising results of tyrosine kinase inhibitors in animal models for PH and fibrosis, only Sorafenib has demonstrated similar effects in human studies, whereas Lenvatinib appears to promote PH development. The impact of Atezolizumab/Bevacizumab on PH remains uncertain, with an increasing risk of bleeding related to Bevacizumab in patients with prior variceal hemorrhage. Given the absence of specific guidelines, endoscopic surveillance during treatment is advisable, and primary and secondary prophylaxis of variceal bleeding should adhere to the Baveno VII recommendations. Furthermore, in patients with advanced HCC, refinement of diagnostic criteria for CSPH and guidelines for its surveillance are warranted.
在接受全身治疗的肝细胞癌患者中，临床显著性门静脉高压的管理已成为关键问题，这主要源于缺乏可靠的诊断标准以及治疗方法的不确定性。本综述旨在强调肝细胞癌与门静脉高压之间关联的主要病理生理学方面，同时探讨当前及新兴的门静脉高压临床管理策略。通过PubMed数据库，使用“肝细胞癌”、“免疫检查点抑制剂”、“全身治疗”、“门静脉高压”、“静脉曲张出血”和“酪氨酸激酶抑制剂”等MeSH术语，对2003年1月至2023年6月的研究进行了回顾。尽管酪氨酸激酶抑制剂在门静脉高压和纤维化的动物模型中显示出有希望的结果，但仅索拉非尼在人体研究中表现出类似效果，而仑伐替尼似乎会促进门静脉高压的发展。阿特珠单抗/贝伐珠单抗对门静脉高压的影响仍不确定，且对于既往有静脉曲张出血史的患者，贝伐珠单抗相关的出血风险增加。鉴于缺乏具体指南，治疗期间进行内镜监测是明智的，且静脉曲张出血的一级和二级预防应遵循《巴韦诺VII共识》。此外，对于晚期肝细胞癌患者，有必要完善临床显著性门静脉高压的诊断标准及其监测指南。
肿瘤(癌症)患者之家