肝细胞癌诊治中的若干问题

王爱平; 温春阳

肝细胞癌诊治中的若干问题

北华大学肝病研究所

详细信息

中图分类号: R735.7
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出版历程
- 出版日期: 2013-01-20

Recent perspectives in hepatocellular carcinoma (HCC) diagnosis and treatment

摘要

摘要:
随着肝细胞癌（HCC）肿瘤标志物和CT/MRI诊断的应用、手术切除及局部消融等治疗方法的进步,使HCC的5年生存率达到了63.4%。但是由于我国HCC早期诊断水平的不均衡,可进行手术切除的病例仅仅有20%～30%。对于高危人群定期开展血清肿瘤标志物和肝脏超声检查;提高三期动态增强CT和Gd-DTPA增强MRI等影像学诊断水平,同时积极开展多学科会诊,制定个性化治疗方案和减少术后肝功能衰竭发生等若干问题,是提高我国HCC早期诊断水平,提高治疗效果,延长生存期的有效手段。
- 癌,肝细胞 /
- 诊断
Abstract:
Recent advances in hepatocellular carcinoma (HCC) diagnostic methods, including sensitive and specific biomarkers and computed tomography (CT) /magnetic resonance imaging (MRI) technologies, and therapeutic strategies, such as surgical resection techniques and local ablation methods, have increased the 5-year survival rate of HCC to 63.4%.However, early diagnosis remains a clinical challenge in China, and only 20%30% of cases are suitable for surgical resection upon diagnosis.To improve early diagnosis rates, screening for serum tumor markers should be increased, along with more frequent ultrasound examinations of high-risk individuals, such as those infected with hepatitis virus.In addition, the high-risk populations should be evaluated by more powerful imaging technologies, such as the three-phase dynamic contrast-enhanced CT and the gadopentetic acid (Gd-DTPA) contrast-enhanced MRI.Upon diagnosis, several aspects of patient management should be enhanced to promote better outcome;specifically, a multidisciplinary consultation approach should be developed to help the patient understand the disease process and healthcare providers to develop effective individualized treatment programs.Collectively, improvements in early diagnosis and patient management will not only help to reduce the rate of late-stage hepatic failure but also improve the overall survival of HCC patients.
- carcinoma /
- hepatocellular

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参考文献(28)

[1]中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作专业委员会, 中华医学会肝病学分会肝癌学组.2009年原发性肝癌规范化诊治的专家共识[J].临床肿瘤学杂志, 2009, 14 (3) :259-269.

[2]Ikoma R, Kaito M, Ishihara T, et al.Early diagnosis of hepa-tocellular carcinoma using a sensitive assay for serum des-gamma-carboxy prothrombin:a prospective study[J].Hep-atogastroenterology, 2002, 49 (43) :235-238.

[3]袁联文, 唐伟.肝癌组织中脱-γ-羧基凝血酶原的测定及意义[J].世界华人消化杂志, 2006, 14 (1) :45-49.

[4]王嘉倍, 刘连新.肝细胞癌生物标记物的研究进展[J].世界华人消化杂志, 2005, 13 (18) :2251-2256.

[5]Tada T, Kumada T, Toyoda H, et al.Relationship betweenLens culinaris agglutinin reactive alpha fetoprotein and patho-logic features of hepatocellular carcinoma[J].Liver Int, 2005, 25 (4) :848-853.

[6]Bertino G, Ardiri A, Malaguarnera M, et al.Hepatocellualarcarcinoma serum markers[J].Semin Oncol, 2012, 39 (4) :410-433.

[7]Toyoda H, Kumada T, Kaneoka Y, et al.Prognostic value ofpretreatment levels of tumor markers for hepatocellular carci-noma on survival after curative treatment of patients withHCC[J].J Hepatol, 2008, 49 (2) :223-232.

[8]Toyoda H, Kumada T, Tada T, et al.Prognostic significanceof a combination of pre-and post-treatment tumor markersfor hepatocellular carcinoma curatively treated with hepatecto-my[J].J Hepatol, 2012, Jul 20.[Epub ahead of print]

[9]Ikoma R, Kaito M, Ishihara T, et al.Early diagnosis of hepa-tocellular carcinoma using a sensitive assay for serum des-gamma-carboxy prothrombin:a prospective study[J].Hep-atogastroenterology, 2002, 49 (43) :235-238.

[10]Colli A, Fraquelli M, Casazza G, et al.Accuracy of ultrasonogra-phy, spiral CT, magnetic resonance, and alpha-fetoprotein indiagnosing hepatocellular carcinoma:a systematic review[J].Am J Gastroenterol, 2006, 101 (3) :513-523.

[11]黄力, 王宁霞, 刘斯润.SPIO在肝脏占位病变MRI诊断中的作用[J].医学影像学临床与研究, 2000, 2 (1) :7-9.

[12]廖伟, 陈丽英, 郭启勇, 等.肝脏特异性磁共振对比剂—菲立磁的临床应用初探[J].临床放射学杂志, 2001, 20 (4) :251-255.

[13]刘松龄, 张云亭, 刘长宏, 等.超顺磁性氧化铁灌注T2WI诊断超急性脑缺血的实验研究[J].中华放射学杂志, 1999, 33 (7) :463-466.

[14]丁义涛, 江春平.肝切除术后肝功能衰竭:病理生理、危险因素与临床治疗[J].中华肝胆外科杂志, 2011, 17 (4) :279-282.

[15]丁义涛, 余德才.原发性肝癌的循证治疗策略[J].中华肝胆外科杂志, 2011, 17 (12) :953-958.

[16]晏建军, 严以群, 周飞国, 等.小肝癌合并严重肝硬化切除术后肝功能衰竭的防治[J].肝胆外科杂志, 2002, 10 (6) :425-427.

[17]中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作专业委员会, 中华医学会肝病学分会肝癌学组.原发性肝癌局部消融治疗的专家共识[J].临床肿瘤学杂志, 2011, 16 (1) :70-73.

[18]Tateishi R, Shiina S, Teratani T, et al.Percutaneous radiofre-quency ablation for hepatocellular carcinoma.An analysis of1000 cases[J].Cancer, 2005, 103 (6) :1201-1209.

[19]王振, 钱叶本.小肝癌射频消融术与手术切除术疗效的Meta分析[J].肝胆外科杂志, 2011, 19 (1) :23-27.

[20]Shiina S, Tateishi R, Arano T, et al.Radiofrequency ablationfor hepatocellular carcinoma:10-year outcome and prognos-tic factors[J].Am J Gastroenterol, 2012, 107 (4) :569-577.

[21]Zhang YJ, Liang HH, Chen MS, et al.Hepatocellular carcino-ma treated with radiofrequency ablation with or without etha-nol injection:a prospective randomized trial[J].Radiology, 2007, 244 (2) :599-607.

[22]陈敏山.肝癌射频消融治疗的现状与展望[J].中华普通外科学文献, 2011, 5 (6) :453-445.

[23]Nishiguchi S, Kuroki T, Nakatani S, et al.Randamised trial ofeffects of interferon-a on incidences of hepatocellular carci-noma in chronic active hepatitis C with cirrhosis[J].Lancet, 1995, 346 (8982) :1051-1055.

[24]Mazzella G, Accogli E, Sottili S, et al.Alpha interferon treat-ment may prevnt hepatocellular carcinoma in HCV-relatedliver cirrhosis[J].J Hepatol, 1996, 24 (2) :141-147.

[25]Lai CL, Yuen MF.Prevention of hepatitis B virus-relatedhepatocellular carcinoma with antiviral therapy[J].Hepatolo-gy, 2012, Jul 13.[Epub ahead of print]

[26]Kurokawa M, Hiramatsu N, Oze T, et al.Effect of interferonalpha-2b plus ribavirin therapy on incidence of hepatocellularcarcinoma in patients with chronic hepatitis[J].Hepatol Res, 2009, 39 (5) :432-438.

[27]Bruix J, Poynard T, Colombo M, et al.Maintenance therapywith peginterferon alfa-2b does not prevent hepatocellularcarcinoma in cirrhotic patients with chronic hepatitis C[J].Gastroenterology, 2011, 140 (7) :1990-1909.

[28]Chen LT, Chen MF, Li LA, et al.Long-term results of arandomized, observation-controlled, phase III trial of adju-vant interferon Alfa-2b in hepatocellular carcinoma after cur-ative resection[J].Ann Surg, 2012, 255 (1) :8-17.

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