從胃腸病學家/肝病學家的角度看肝細胞癌

StephenW

Hepatocellular carcinoma from the view of gastroenterologist/hepatologist
Urbánek Petr, Hříbek Petr

    PMID: 33213164 DOI: 10.14735/amko20203S34

Abstract

Hepatocellular carcinoma (HCC) is one of the major complications of chronic liver disease, mostly of liver cirrhosis. Liver diseases from different causes differ in the risks of HCC development. Different mechanisms of carcinogenesis are involved in HCC development in different liver diseases as well. Generally, two main pathways are distinguished: the cause of liver disease itself (e.g. viral infections, accumulation of heavy metals etc.) and chronic liver inflammation and fibrogenesis, including mechanisms of oxidative stress. Rare cases of HCC in liver without underlying cirrhosis are likely the consequences of the mechanisms directly linked with particular etiological factor (e.g. protein X in chronic hepatitis B virus (HBV) infection). The key approach which can lead to significantly better results of any treatment used in HCC cases is HCC screening and surveillance. The appropriate method of HCC surveillance is abdominal ultrasonography in 6-month intervals. There is still one question to be solved: the correct definition of target population which should undergo this method of surveillance. Currently, the target population in the developed world is defined as all patients with liver cirrhosis. Unfortunately, the only method of primary prevention of HCC is available: universal HBV vaccination. Antiviral treatment of hepatitis B or C is considered as a method of secondary prevention. Adjuvant therapy of HCC after its primary therapy (antiviral therapy after HCC resection etc.) and other measures able to reduce HCC recurrence risk are usually mentioned as tertiary prevention approach. The BCLC staging system is the most common system used in Europe for the classification of HCC at the dia-gnosis. This classification combines the stage of HCC itself with other parameters, such as liver disease severity (Child - Pugh classification), portal hypertension etc. BCLC is a system which guides the physicians to optimal treatment options in every HCC stage. The only potentially curable approaches are surgical resection or liver transplantation. These options may be used in 1/3 of all HCC patients. Unfortunately, the vast majority of HCC patients can be treated only by palliative treatment options with transarterial chemoembolisation being the most common one.

Keywords: chronic hepatitis B; chronic hepatitis C; hepatocellular carcinoma; non-alcoholic steatohepatitis.

StephenW

從胃腸病學家/肝病學家的角度看肝細胞癌
UrbánekPetr，赫里貝克·彼得

    PMID：33213164 DOI：10.14735 / amko20203S34

抽象

肝細胞癌（HCC）是慢性肝病（主要是肝硬化）的主要並發症之一。各種原因引起的肝病在肝癌發生的風險上有所不同。在不同的肝臟疾病中，肝癌的發展也涉及不同的致癌機制。通常，主要途徑有兩個：肝臟疾病本身的病因（例如病毒感染，重金屬的積累等）和慢性肝臟炎症和纖維化，包括氧化應激的機制。肝臟中沒有基本肝硬化的罕見肝癌病例可能是與特定病因直接相關的機制的結果（例如慢性乙型肝炎病毒（HBV）感染中的X蛋白）。肝癌篩查和監測是可以顯著改善肝癌病例治療效果的關鍵方法。適當的HCC監測方法是每6個月進行一次腹部超聲檢查。仍然有一個問題需要解決：應該進行這種監視方法的目標人群的正確定義。目前，發達國家的目標人群是所有肝硬化患者。不幸的是，只有一種預防HCC的唯一方法：通用HBV疫苗接種。乙肝或丙肝的抗病毒治療被認為是二級預防方法。作為三級預防方法，通常提到在其主要治療後進行HCC的輔助治療（HCC切除後的抗病毒治療等）和其他能夠降低HCC復發風險的措施。 BCLC分期系統是歐洲用於診斷HCC的最常用系統。此分類將HCC本身的階段與其他參數結合在一起，例如肝病嚴重程度（Child-Pugh分類），門靜脈高壓等。BCLC是一個系統，可以指導醫生在每個HCC階段均獲得最佳治療選擇。唯一可能治癒的方法是手術切除或肝移植。這些選項可用於所有HCC患者的1/3。不幸的是，絕大多數HCC患者只能通過姑息治療選擇進行治療，其中最常見的治療方法是經動脈化學栓塞。

關鍵詞：慢性乙型肝炎；慢性丙型肝炎；肝細胞癌；非酒精性脂肪性肝炎。

StephenW

https://www.linkos.cz/files/klinicka-onkologie/481/5823.pdf