原发性肝癌规范化病理诊断指南(2015年版)

<正>我国是世界上肝癌高发国家之一,手术切除是肝癌的首选治疗方法,而病理学则是肝脏外科最主要的支撑学科之一。为此,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和中华医学会病理学分会全国肝胆肿瘤及移植病理协作组于2010年制订了《原发性肝癌规范化病理诊断方案专家共识(2010年版)》(简称《共识》)[1],对推进我国肝癌病理诊断规范化起到了积极的引导作用。近5年来,肝癌临床和病理学研究又有了新进展,肝癌异质性、生物学特性、分子分型和个体化治疗等新概念开始成为现代临床肝癌治疗学的基本指导思想,这对肝癌病理诊断的规范化和标准化提出了更高的要求。为此,2014年4     

肝癌临床研究新进展

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

重视原发性肝癌治疗的规范化

原发性肝癌患者病情复杂,宜根据病变的具体情况和各种治疗方法的不同特点和适应证选择最佳个体化方案.原发性肝癌的规范化治疗涉及诸多学科,需要多学科共同探讨,为患者选择最合适的首选治疗及综合治疗方案,对提高肝癌的总体疗效和改善患者的预后具有重要意义.为此,中国抗癌协会肝癌专业委员会(CSLC)和临床肿瘤学协作专业委员会(CSCO)以及中华医学会肝病学分会肝癌学组联合进行了深入研讨,形成了基本共识,对推动我国肝癌的规范化治疗作出了贡献.     

Malignant progression of a small HCC nodule: Hypovascular ‘early HCC’ converted to hypervascular ‘small HCC’ within six months

We report a case of hepatocellular carcinoma superimposed on chronic hepatitis C virus (HCV) hepatitis in which final diagnosis of hepatocellular carcinoma was delayed because there was no consensus on hypervascularity with two diagnostic methods at the time of presentation. A 3 cm lesion was initially observed as hypovascular at multidetector-row computed tomography. Conversely, two months later the lesion appeared hypervascular at contrast-ultrasonography and gadolinium-enhanced dynamic magnetic resonance, and hyperintense after superparamagnetic iron oxide-enhanced T2W studies. Only in the late follow-up it was definitively confirmed as hypervascular in the arterial phase of multidetector-row computed tomography. This case clearly highlights some pitfalls in the European Association for the study of the liver guidelines for hepatocellular carcinoma management, which were readdressed in the last American Association for the Study of Liver Diseases (AASLD) and in the forthcoming international proposals, leading to more pragmatic suggestions for clinical practice.     

High amino acid variability within the NS5A of hepatitis C virus (HCV) is associated with hepatocellular carcinoma in patients with HCV-1b-related cirrhosis.

Interferon therapy may decrease the risk of hepatocellular carcinoma in patients with hepatitis C virus (HCV)-related liver cirrhosis. Interaction of the cellular protein kinase PKR with the PKR-binding domain (PKR-bd) of HCV-NS5A protein may affect cellular growth control and viral resistance to interferon therapy. Mutations within the PKR-bd, which comprises the interferon sensitivity determining region (ISDR), have been associated with interferon sensitivity. To determine whether or not there is an association between HCV heterogeneity and the presence of hepatocellular carcinoma, HCV-1b genomic regions were amplified and directly sequenced from serum samples obtained from 82 patients with liver cirrhosis, 53 with, and 29 without hepatocellular carcinoma. None of them had received antiviral therapy. When compared with the deduced consensus sequence, the median number of amino acid changes in the PKR-bd was higher among samples from patients with (4.22) than from those without hepatocellular carcinoma (1.62; P <.001), and isolates with 3 or more amino acid changes were significantly more common among the former (60%) than among the later (6%, P <.001). No such differences were observed in other viral regions, including Core, E2-HVR-1, E2-PePHD, NS3, and the 5' and 3' PKR-bd flanking regions. In addition, amino acid variation in viral regions other than HVR-1 did not accumulate over time in the analyzed sequential serum samples obtained from patients with or without hepatocellular carcinoma. Therefore, a mutated HCV-PKR-bd phenotype is very common in cirrhotic patients with hepatocellular carcinoma.     

Multimodale Therapie des hepatozellulären Karzinoms

Hepatocellular carcinoma represents one of the most important tumor entities worldwide. The great majority of these cases in Germany can be attributed to chronic liver disease (alcohol, viral hepatitis among others), which lead to development of liver cirrhosis and ultimately to hepatocellular carcinoma. While our understanding of the pathophysiological principles underlying the origin of hepatocellular carcinoma has increased considerably in recent years, the prognosis of the majority of these patients remains poor. However, a combined interdisciplinary approach involving internists, surgeons, and radiologists can often achieve effective palliative treatment of the disease. This has recently been reinforced by applying systemic therapies which specifically influence the important biological processes of hepatocellular carcinoma. It can be assumed that by adhering to well-defined treatment algorithms and using improved drug therapy the prognosis of patients with this form of cancer will improve in the future.     

Prevention of hepatocellular carcinoma in chronic liver disease: molecular markers and clinical implications

The development of hepatocellular carcinoma is generally preceded by chronic liver damage leading to cirrhosis. Prevention of chronic liver diseases can decrease the incidence of hepatic cancer impressively. Many recent investigations have also explored the power of secondary and tertiary prevention in established liver cirrhosis. Screening programs for patients at high risk, antiviral treatment of patients with progressed hepatitis, and adjuvant interventions after curative resection are some of the approaches. However, the cost effectiveness and benefits of such procedures and the prognosis is also dependent on the remaining liver function, there is no consensus to date on how patients should be handled. In the future molecular markers and prognostic scores may help better define the group at risk of developing. To give a perspective to these patients, it is necessary to improve the treatment of hepatocellular carcinoma as well as cirrhosis.     

Vascular endothelial growth factors and liver diseases

Vascular endothelial growth factor plays an important role in neovascularization both in normal tissues and most tumors. It has been extensively investigated recently in various hepatic diseases such as primary and secondary hepatocellular carcinoma, liver cirrhosis, hepatitis and even benign tumors in liver. Vascular endothelial growth factor has been verified to be closely involved in the development and metastases of hepatocellular carcinoma and correlated to the high risk of hepatic metastases and a poor prognosis in gastrointestinal cancer. Using antibodies to vascular endothelial growth factor or other drugs to suppress its expression has also been successfully tried to restrain hepatocellular carcinoma cells and metastases in vitro and in animal models. The protein of vascular endothelial growth factor has an inclination to increase in acute and chronic hepatitis and tends to decrease in cirrhosis both in tissue expression and circulating levels. This circulating level is closely related to the Child-Pugh classification in cirrhotic liver. However, there are indeed some disagreements concerning vascular endothelial growth factor and liver disease, for example, opinions on the positive rates of vascular endothelial growth factor in protein and mRNA level are far from reaching a general consensus. Further study should be performed in the future in antitumor research and its significance in the process of liver cirrhosis.     

Surgical therapy of hepatocellular carcinoma

There is no worldwide consensus of an algorithm for the radical treatment of hepatocellular carcinoma (HCC). Surgical resection, liver transplantation and, recently, local ablation therapies achieve high curative rates in selected patients. However, recurrence of HCC remains a major problem. This review provides an overview of the current surgical treatment options available for patients with HCC.     

Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma

Background  

There is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments. This study is a meta-analysis of the available evidence.     

肝细胞癌分期系统的临床意义与进展

大多数实体瘤患者肿瘤的诊断和分期与其生存期有关,且直接影响治疗指征。肝细胞癌患者生存期的预测较复杂,目前国际上对肝细胞癌分期系统尚无统一的认识。若分期系统只考虑预后参数,如肿瘤、淋巴结、转移或Child—Pugh分级中的一种,那该分期系统是无用的。已建立的几个分期系统,均对终末期患者有确定能力而与治疗无关联。巴塞罗纳临床肝细胞癌分期系统是在几个队列和临床随机研究结果基础之上建立的,集肿瘤状态、治疗方案与预测生存期为一体的分期系统。     

慢性HBV感染免疫耐受期应否治疗?

国际主要指南对慢性HBV感染免疫耐受期的定义不完全一致,但几乎所有指南均不推荐对免疫耐受期慢性乙型肝炎患者启动治疗。本文讨论了关于对HBV感染免疫耐受期患者进行抗病毒治疗的最新证据,以预防其肝硬化和肝细胞癌的发生。     

Optimizing curative management of hepatocellular carcinoma

The goal of curative management of hepatocellular carcinoma is to provide the best chance of remission. However, recurrence rates for both local and distant relapse are high. Patient subgroups at higher risk of these events can be identified based on histological patterns that are closely linked to specific molecular subtypes. Patient outcome has improved with more effective therapeutic strategies thanks to technological advances in surgical techniques and percutaneous ablation. The main goal of controlling the cause of liver disease is to decrease distant/late recurrence and prevent deterioration of hepatic function. Ongoing trials testing the combination of neoadjuvant and/or adjuvant regimens with these procedures as well as routine tumour molecular analysis may modify therapeutic algorithms for hepatocellular carcinoma in the future.