Molecular prognostic prediction in liver cirrhosis
Molecular prognostic prediction in liver cirrhosis
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DOI：
10.3748/wjg.v21.i36.10262
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发表时间：
2015-09-28
影响因子：
4.3
通讯作者：
Hoshida, Yujin
中科院分区：
文献类型：
--
作者：
Goossens, Nicolas;Nakagawa, Shigeki;Hoshida, Yujin
肝硬化的自然史各不相同，因此，鉴于患者人数众多，预后预测至关重要。已经开发了各种临床预后指标，并使患者风险分层，尽管它们的性能有些有限，特别是在疾病的相对早期阶段。分子预后指标有望改善预测，并可能将一部分患者与抵消不良预后的分子靶向干预联系起来。在这里，我们概述了文献中的临床和分子预后指标，并讨论了成功定义，评估和部署预后指标作为临床评分或测试的关键问题。由于纤维化评估的采样变异性和基于成像或实验室检查的纤维化评估方法的出现，肝活检的使用已经减少。然而，近年来基因组学技术和选择性分子靶向药物的快速发展，使得对活检组织标本的需求日益突出，需要探索和建立分子信息指导的个性化/分层临床护理，最终实现“精准医疗”。
The natural history of cirrhosis varies and therefore prognostic prediction is critical given the sizable patient population. A variety of clinical prognostic indicators have been developed and enable patient risk stratification although their performance is somewhat limited especially within relatively earlier stage of disease. Molecular prognostic indicators are expected to refine the prediction, and potentially link a subset of patients with molecular targeted interventions that counteract poor prognosis. Here we overview clinical and molecular prognostic indicators in the literature, and discuss critical issues to successfully define, evaluate, and deploy prognostic indicators as clinical scores or tests. The use of liver biopsy has been diminishing due to sampling variability on fibrosis assessment and emergence of imaging- or lab test-based fibrosis assessment methods. However, recent rapid developments of genomics technologies and selective molecular targeted agents has highlighted the need for biopsy tissue specimen to explore and establish molecular information-guided personalized/stratified clinical care, and eventually achieve "precision medicine".