医学课件肝细胞癌英文版VIP免费

HepatocellularcarcinomaEpidemiology•HCCistheseventhmostcommoncancerworldwide,andthethirdleadingcauseofcancer-relateddeaths.•Morethan600,000newcasesworldwideannually(50%inChina)•Over80%ofHCCsoccurindevelopingcountries–sub-SaharanAfrica,southeastAsia,andeastAsia•IncidencedecreasedindevelopingcountriesandincreasedindevelopedcountriesYangJD,etal.NatureRev2010GlobalvariationinincidenceofHCCYangJD,etal.NatureRev2010Etiology•HepatitisB:50%HCCattributedtoHBVworldwide–Around100timeshigherforincidenceofHCCincarriersthannoncarriers•HepatitisC:leadingcauseofHCCinWesterncountriesandJapan•AflatoxinB:synergisticfactorwithHBVinChinaandsub-SaharanAfrica•Alcoholicliverdisease:secondmostcommonriskfactorforHCCafterHCVinUSA•Nonalcoholicsteatohepatitis(NASH):anemergingriskfactorindevelopedcountriesPrevention•VaccinationofHBV–ReducedHCCincidenceafteruniversalvaccinationofnewbornbabies–LamivudinetreatmentreducedincidenceofHCCinhepatitisBorresultantcirrhosis•PreventionofHCVtransmission–NovaccinationforHCV–Infectioncontrolmeasuresinhighriskpractices(screeningblooddonors,useofdisposableneedles,thoroughsterilizationofsurgicalinstruments)–InterferonandribavirinforhepatitisCPathologyofHCC•Differentiation–Edmondsongrade:I,II,III,IV•Portalveininvasion–Microvessel,macrovessel(portalvein,hepaticvein,Inferiorvenacava)•Metastasis–Distantmetastasis:lung,lymphnodule,bone,adrenalgland,brain)Tumormarkers•Alpha-fetoprotein(AFP)–HCC:60%70%withelevatedAFP–Others:•ActiveHepatitis,livercirrhosis•Livermetastasis:Gastriccancer,pancreaticcancer,kidneycancer,embryonictumors•des--carboxyprothrombin(DCP)Imagines•Ultrasonography•Dynamiccomputedtomography(CT)•Magneticresonanceimagine(MRI)•AngiographySurveillanceofHCC•IndividualshighriskforHCC–Hepatitis•menover40years,womenover50years•Patientswithpersistentlyorintermittentlyelevatedalaninetransaminase(ALT)levels–Livercirrhosis•HepatitisBorCrelated•Alcoholicliverdisease•Hemochromatosis•Primarybiliarycirrhosis•Howtocarryoutthescreening–UltrasonographyincombinationwithserumHCCmarker,alpha-fetoprotein(AFP),every6monthsDiagnosis•AmericanAssociationforthestudyofliverDiseases(AASLD)–Lesion1.0cm,withHCCfeatures(enhancementinarteryphaseandwashoutinvenousphase)ononeofDynamicimagines(CTorMRI)–BiopsyDiagnosisofHCCBruixJandShermanM,Hepatology2011DiagnosisofHCCLivercirrhosisCT/MRIOrbiopsyStagingsystems•BarcelonaClinicliverCancer(BCLC)•CanceroftheliverItalianProgram(CLIP)•TNM(tumor,nodeandmetastasis)•Okuda•JapaneseIntegratedstagingscore(JIS)systemsBCLCstageBruixJandLlovetJM,Lancet2009Differentialdiagnosis•Livermetastasis–Colorectal,pancreatic,breast,lung;•Intrahepaticcholangiocarcinoma•Angioma•Livercysts•LiverAbscessTreatment•Surgicaltreatment–Surgicalresection–livertransplantation•Transarterialchemoembolizaion•Localablation–Percutaneousethanolinjection(PEI)–Radiofrequencyablation(RFA)•Radiation•Syctemictherapy–Chemotherapy,immunotherapy,moleculartargettherapySorafenibSorafenibinadvancedHCCMediansur6.5mvs4.2mP=0.014Mediantimetoprogress2.8mvs1.4mP=0.0005ChengALetal.LancetOncol2009Prognosis•Tumorstage–Size,nodules,portalveininvolvement,metastasis–Biomarkers•Liverfunction–Child-Pugh•ECOGperformanceThanksUltrasonographyMRIT1WT2WArteryphaseVenousphaseCTNonenhancement,EnhancementinarteryphasewashoutinvenousphaseangiographyPancreaticcancermetastasistotheliverIntrahepaticcholangiocarcinomaangiomaLivercystSurgicalresectionn5-yOStransplantation46875.7%surgicalresectionsamlllivercancer505957.0%largelivercancer486030.3%TransarterialchemoembolizationPercutaneousethanolinjectionRadiofrequencyablationRFAforHCCSmallHCCtreatedwithradiofrequencyablation（zhongshanhospitaln=864)•≤5cm:–Medialsurvival42m–5-yearsurvavalrate:34.7%•≤3cm:–Medialsurvival62m–5-yearsurvvalrate：50.6%P<0.0001