Prognostic prediction and treatment strategy in hepatocellular carcinoma
Prognostic prediction and treatment strategy in hepatocellular carcinoma
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DOI：
10.1053/jhep.2002.32089
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发表时间：
2002-03-01
期刊：
影响因子：
13.5
通讯作者：
Llovet, JM
中科院分区：
文献类型：
--
作者：
Bruix, J;Llovet, JM
肝癌是世界上第五大常见癌症（564，000例/年），也是癌症相关死亡的第三大原因。2这一统计数据反映了慢性HCV感染的长期后果和诊断该疾病的能力提高。主要由B和C型肝炎病毒引起的肝硬化是HCC的主要危险因素，5年累积发病率在15%至20%之间。3肝硬化男性伴甲胎蛋白浓度升高的风险最高。单用干扰素或联合利巴韦林抗病毒治疗可根除病毒感染并防止进展为肝硬化。然而，没有证据支持其预防肝硬化的作用。4监测是潜在降低肿瘤相关死亡率的唯一策略，因为它可以在早期发现HCC，此时可以应用治愈性治疗。4没有随机对照试验（RCTs）比较监测和无监测。队列研究和成本效率建模支持其在明确定义的候选人中的益处。监测应仅限于那些如果诊断为HCC而值得有效治疗的患者。这将排除晚期阿尔茨海默病患者（Child-Pugh C级）和具有严重相关疾病的患者。Child-Pugh C级患者应考虑进行肝移植（LT）。如果这是不可用的或病人不是候选人的这一选择，监测是不符合成本效益的。3肿瘤体积倍增时间的数据为目前推荐的监测政策提供了依据：超声（US）和每6个月测定一次甲胎蛋白。3通过应用这一政策，40%至80%的肝癌被发现是孤立的，但只有一半的人得到根治。5，6诊断确认是治疗适应症之前的一个关键方面。多年来，这是基于细胞组织学，但可靠的非侵入性标准，为阿尔茨海默病患者最近已经发展。
Liver cancer is the fifth most common cancer in the world (564,000 cases/year) and the third cause of cancer-related death. 2 This statistic reflects the long-term consequences of chronic HCV infection and an increased capability to diagnose the disease. Cirrhosis, mainly caused by hepatitis B and C viruses, constitutes the main risk factor for HCC, with the 5-year cumulative incidence ranging between 15% to 20%. 3 Cirrhotic men with increased-fetoprotein concentration bear the highest risk. Antiviral treatment with interferon alone or associated with ribavirin may eradicate viral infection and prevent progression to cirrhosis. However, there is no evidence to support its preventive effect once cirrhosis is established. 4Surveillance is the sole strategy to potentially decrease tumorrelated mortality because it may detect HCC at an early stage, when curative therapies can be applied. 4 There are no randomized controlled trials (RCTs) comparing surveillance with no surveillance. Cohort studies and cost-efficiency modeling support its benefits in well-defined candidates. Surveillance should be restricted to cirrhotics who would merit effective treatment if diagnosed with HCC. This discards advanced cirrhotic patients (Child-Pugh class C) and those with severe associated conditions. Child-Pugh class C patients should be considered for liver transplantation (LT). If this is not available or the patients are not candidates for this option, surveillance is not cost effective. 3 Data on tumor volume doubling time provide the rationale for the current recommended surveillance policy: ultrasound (US) and-fetoprotein determination every 6 months. 3 By applying this policy, 40% to 80% of HCCs detected are solitary, but only half of them are radically treated. 5, 6 Diagnostic confirmation is a key aspect prior to treatment indication. For years, this was based on cyto-histology, but reliable noninvasive criteria for cirrhotic patients have been recently devel-