肝癌的早期诊断和治疗

Early diagnosis and therapy for HCCDepartment of Infectious Diseases The 2nd affiliated hospital CQMU1

Why us ?

Hepatobiliary surgeons Interventional radiologists Oncologists.

As a result, the role of the hepatologist traditionally has been limited to making the diagnosis and providing care of the underlying liver disease.2

NEW ROLE

Assessing the patient’s liver disease status, and carefully managing the liver disease before and during treatment. Deciding what form of therapy is most appropriate and whether the patient’s liver function would allow that form of therapy to be given. Instituting surveillance for HCC and manage the investigation of abnormal results. Deciding whether or not to offer liver transplantation to patients with HCC.3

Why at early stage?

HCC detected after the onset of symptoms has a dismal prognosis(0%-10% 5-year survival). Five-year disease-free survival exceeding 50% has been reported for both resection and liver transplantation. For the subjects in the surveillance arm the HCC related mortality was reduced by 37%.

What is early stage?

WHO should be offered Surveillance?Hepatitis B carriers Asian males ≥ 40 years Asian females ≥ 50 years Africans over age 20 Family history of HCC All cirrhotic hepatitis B carriers For non-cirrhotic hepatitis B carriers not listed above the risk of HCC varies depending on the severity of the underlying liver disease, and current and past hepatic inflammatory activity. Patients with high HBV DNA concentrations and those with ongoing hepatic inflammatory activity remain at risk for HCC.9

HBV infection and Hepatocellular carcinoma

Prevelence rate of HBsAg <2% 2–7% >8% Non-available

Morbility of primary HCC 1–3 3–10 10–150 Non-availableWHO. 2003

Non-hepatitis B cirrhosisHepatitis C Alcoholic cirrhosis Genetic hemochromatosis Primary biliary cirrhosis Alpha1-antitrypsin deficiency Non-alcoholic steatohepatitis Autoimmune hepatitis 11

How to screen?

Screening—application of diagnostic tests in patients at risk for HCC, but in whom there is no a priori reason to suspect that HCC is present. Surveillance—the repeated application of screening tests. Enhanced follow-up —the series of investigations required to confirm of refute adiagnosis of HCC in patients in whom a surveillance test result is abnormal.In addition to the use of additional diagnostic tests the interval between assessments is shorter than for surveillance since there is a concern that acancer already exists.12

A screening test should be able to identify early disease, not late disease.

Serological: AFP(sensitivity 60%)Radiological: ultrasonography sensitivity (65% - 80%) and specificity(>90%)

The ideal surveillance interval is not known. A surveillance interval of 6-12 months has been proposed based on tumor doubling t

imes. The surveillance interval is determined by the tumor growth rates and not by the degree of risk. However, it is important to make the distinction between patients undergoing surveillance and those in whom surveillance tests have been abnormaland there is a concern that HCC is already present.14