肝癌的分子分型与肝癌的诊治

肝癌是世界范围内第5大恶性肿瘤,在中国肝癌是第2大癌症死因。肝癌的治疗至今仍然以外科手术切除或肝移植为最佳选择。但肝癌患者的预后却大不相同,即使是小于3cm的小肝癌,有的患者可生存达10年或20年之久,有些则在1年内复发,数月后死亡。根据目前的形态学分类或病理学分型则很难分析和理解这种差异性结果的原因。     

原发性肝癌的分子诊断

原发性肝癌（primarycarcinomaoftheliver）是我国常见恶性肿瘤之一。死亡率高,存恶性肿瘤死亡顺位中仪次于胃、食道而居第三位。近年来随着各种诊断技术的不断发展,对原发性肝癌的诊断也有了一个新的商度,各种诊断方法和诊断标准正日益趋于完善,本文旨在介绍近年来主要用于临床诊断原发性肝癌的各种分子诊断标准及其常用方法。     

原发性肝癌的分子诊断

全世界每年新发现的恶性肿瘤患者约 635 万例,肝癌26万例,其中42.5%发生在中国.肝脏原发肿瘤中90%以上为恶性肿瘤,而原发性肝癌的发病率居肝脏恶性肿瘤之首,是我国常见的恶性肿瘤之一,其死亡率在消化道肿瘤中占第3位,仅次于胃癌与食管癌.近年来,随着分子生物学、细胞生物学和人类基因组学、蛋白质组学等基础学科向癌症研究领域的延伸,肝癌分子诊断的研究取得了长足的进展,下面简单介绍一下肝癌相关的分子诊断方法和分子诊断要点.     

乳腺癌分子分型研究进展

长期以来,组织病理学诊断是肿瘤诊断的＂金标准＂和临床治疗的基础,但组织学类型、TNM分期都相同的肿瘤如采取相同的治疗方案,患者对治疗的反应和预后并不一致。事实上,恶性肿瘤（包括乳腺癌）是一类分子水平上高度异质性的疾病,组织学形态相同的肿瘤,其分子遗传学改变不尽一致,从而导致肿瘤治疗反应和预后的差别。传统病理形态学诊断已不能适应现代肿瘤诊治的需要。     

肝细胞癌的分子分型研究进展

肝细胞癌(hepatocellular carcinoma)全球每年新发病例约564 000例,其中男性约398 000例,女性约166 000例[1].在各种癌症中,肝细胞癌的死亡率位居第3, 仅次于肺癌和结肠癌[2-3].因此,肝细胞癌的早期发现、分型、诊断和治疗对提高肝细胞癌患者的预后有相当重要的意义.而传统的肝细胞癌临床分型(TNM分期、Edmondson分级等),主要是依据肿瘤瘤体的形态(大小、数目、分布、质地)、淋巴结和远处转移情况、病理检查结果(肿瘤组织细胞类型、分化程度)等特征得出,并以此为依据而采取适当的治疗手段和方法.     

肝细胞癌的分子分型研究进展

肝细胞癌（hepatocellular carcinoma）全球每年新发病例约564000例,其中男性约398000例,女性约166000例。在各种癌症中,肝细胞癌的死亡率位居第3,仅次于肺癌和结肠癌。因此,肝细胞癌的早期发现、分型、诊断和治疗对提高肝细胞癌患者的预后有相当重要的意义。而传统的肝细胞癌临床分型（TNM分期、Edmond、Son分级等）,     

丙型肝炎病毒基因分型与临床分子诊断

丙型肝炎基因分型对于分子流行病学研究、预测慢性丙型肝炎病情和抗病毒治疗效果具有重要的意义。本文就近年来丙型肝炎基因分型的意义、方法和临床应用情况作简要述评。     

肝癌临床诊治的新观念

肝细胞性肝癌在全球占最常见的恶性肿瘤的第5位,已经成为我国癌症死因中第2位的肿瘤.每年全世界大约有50万～100万新发病例,中国的肝癌发病人数占全球总数的一半以上.因此近年来有关肝癌诊断和治疗的各种研究迅速增多,新药和新的疗法也快速地应用到临床上[1-4].80%～90%的肝癌是在肝硬化的基础上发病,而在我国肝硬化的主要病因是乙型肝炎.     

肝癌临床诊治的新观念

肝细胞性肝癌在全球占最常见的恶性肿瘤的第5位,已经成为我国癌症死因中第2位的肿瘤。每年全世界大约有50万～100万新发病例,中国的肝癌发病人数占全球总数的一半以上。因此近年来有关肝癌诊断和治疗的各种研究迅速增多,新药和新的疗法也快速地应用到临床上。     

复发性肝癌的临床特征与诊治

1 引 言 复发性肝癌是指肝癌经手术切除或放射治疗或化学治疗等治疗后已清除的癌灶再次复发,其临床特点与原发性肝癌不同。2 复发性肝癌的临床特征2．1 高复发率 肝癌术后复发者约占50％以上,Brighiti报道5年复发率高达100％,主要原因有：①术前可能存在肉眼难以观察到的微小癌灶;②术中未能彻底清除已发生的微小癌转移灶;③手术造成种植性转移。2．2 高危险期 陈汉等报道,41例首次肝癌切除术后半年复发7例（17％）,7个月至1年内复发10例（24％）,1年至1．5年复发5例（12％）,一年半以上至2年复发8例（20％）,2年内复发共30例,…     

Molecular classification of gastric cancer

Introduction: Gastric cancer is among the most common cancers worldwide. Despite declining incidences, the prognosis remains dismal in Western countries and is better in Asian countries with national cancer screening programs. Complete endoscopic or surgical resection of the primary tumor with or without lymphadenectomy offers the only chance of cure in the early stage of the disease. Survival of more locally advanced gastric cancers was improved by the introduction of perioperative, adjuvant and palliative chemotherapy. However, the identification and usage of novel predictive and diagnostic targets is urgently needed.

Areas covered: Recent comprehensive molecular profiling of gastric cancer proposed four molecular subtypes, i.e. Epstein-Barr virus-associated, microsatellite instable, chromosomal instable and genomically stable carcinomas. The new molecular classification will spur clinical trials exploring novel targeted therapeutics. This review summarizes recent advancements of the molecular classification, and based on that, putative pitfalls for the development of tissue-based companion diagnostics, i.e. prevalence of actionable targets and therapeutic efficacy, tumor heterogeneity and tumor evolution, impact of ethnicity on gastric cancer biology, and standards of care in the East and West.

Expert commentary: The overall low prevalence of actionable targets and tumor heterogeneity are the two main obstacles of precision medicine for gastric cancer.     

Molecular classification and correlates in colorectal cancer

Molecular classification of colorectal cancer is evolving. As our understanding of colorectal carcinogenesis improves, we are incorporating new knowledge into the classification system. In particular, global genomic status [microsatellite instability (MSI) status and chromosomal instability (CIN) status] and epigenomic status [CpG island methylator phenotype (CIMP) status] play a significant role in determining clinical, pathological and biological characteristics of colorectal cancer. In this review, we discuss molecular classification and molecular correlates based on MSI status and CIMP status in colorectal cancer. Studying molecular correlates is important in cancer research because it can 1) provide clues to pathogenesis, 2) propose or support the existence of a new molecular subtype, 3) alert investigators to be aware of potential confounding factors in association studies, and 4) suggest surrogate markers in clinical or research settings.     

肝癌的综合治疗之我见

原发性肝癌是全球常见的恶性肿瘤,预后差,死亡率高。关于肝癌的分期,我国目前多采用2011年制定的"肝癌多学科综合治疗模式"或BCLC分期标准。各分期标准中包含了肝癌的各种治疗方法,其中,手术治疗主要包括肝移植和肝肿瘤局部切除;非手术治疗主要包括肝肿瘤局部消融(如射频消融、微波消融、氩氦冷冻消融、瘤内无水乙醇注射、瘤内乙酸注射等)、经肝动脉化疗栓塞、系统治疗(分子靶向药物、系统化疗)、放射治疗、免疫治疗、中医中药治疗等。目前为止,肝癌手术切除依然是首选方法。但每一种治疗方法都有其严格的适应证;而且每种方法在实施过程中都有各自的副作用,如肝功能损伤、肝硬化进展、肝炎病毒再激活、免疫功能低下等。总之,肝癌的治疗是一个综合治疗的过程——既要治疗肿瘤,还要有效控制肝炎病毒,维护肝脏功能,维护患者体力和生活质量;在治疗肿瘤时,要适时、适度、严格掌握适应证;既要狠狠打击肿瘤,又要最大限度地保护机体。延长患者生存期是肝癌治疗的唯一目的。     

原发性肝癌的诊断和治疗

原发性肝癌在世界范围内是第五位最常见和第三位致死率最高的恶性肿瘤。据世界卫生组织公布的2004年全球疾病负担数据,全球每年新发肝癌632000例,其中西太平洋地区每年新发386000例。我国是原发性肝癌的高发区,占全球肝癌病例的55％。因此,对原发性肝癌的诊治进行探讨、研究具有十分重要的意义。原发性肝癌按照细胞来源分为肝细胞癌、胆管细胞癌和混合细胞癌。由于胆管细胞癌特殊的生物学特性,加之在临床占原发性肝癌的10％～20％,本文主要阐述肝细胞癌的诊断和治疗。     

Guidelines for treatment of liver cancer.

In the treatment of hepatocellular carcinoma, the range of indications for percutaneous ablation techniques is becoming wider than surgery and intra-arterial therapies. Indeed, whereas for some years only patients with up to three small lesions were treated, with the introduction of the single-session technique under general anesthesia, even patients with more advanced disease are now being treated. Although it is understood that partial resection assures the highest local control, the survival rates after surgery are roughly comparable with percutaneous ethanol injection (PEI). The explanation is due to a balance among advantages and disadvantages of the two therapies. PEI survival curves are better than curves of resected patients who present adverse prognostic factors, and this means that surgery needs a better selection of the patients. Indications for both therapies are reported. Single-session radiofrequency (RF) ablation seems to offer better results in terms of local control and safety than transarterial chemoembolisation (TACE) in multifocal tumours. An open question remains the choice between PEI and other new ablation procedures. In our department, we use RF, PEI and segmental TACE, according to the features of the disease. In the treatment of colorectal liver metastases, the initial survival curves of thermal ablation techniques are promising. However, they are size and site dependent, so partial resection remains the gold standard. An interesting indication seems to be the treatment of breast liver metastases in selected patients.