原发性肝癌PPT培训课件VIP免费

原发性肝癌原发性肝癌韩国宏第四军医大学第一附属医院内科教研室韩国宏第四军医大学第一附属医院内科教研室Long-TermRelativeSurvivalRatesforPatients(Diagnosed,SEERProgram,AllRaces,MenandWomen)Long-TermRelativeSurvivalRatesforPatients(Diagnosed,SEERProgram,AllRaces,MenandWomen)PrimarySite5-YearRelativeSurvivalRate(%)Allsites60Brain30Breast85Colon63Esophagus12Hodgkin’sdisease82Kidney61Larynx66Leukemia43Liver7Lungandbronchus14Melanoma88Multiplemyeloma29Non-Hodgkin’slymphomas51Oralcavityandpharynx53Pancreas4Prostate93Rectum61Stomach21Thyroidgland95Urinarybladder82一、组织学分型肝细胞癌（HCC）85-90%Hepatocellularcarcinoma胆管细胞癌（CCC）5%Cholangiocellularcarcinoma混合细胞癌（HCC+CCC）5%一、组织学分型肝细胞癌（HCC）85-90%Hepatocellularcarcinoma胆管细胞癌（CCC）5%Cholangiocellularcarcinoma混合细胞癌（HCC+CCC）5%二、流行病学肝细胞癌发生于世界范围，尤其是我国等亚洲和非洲国家肝细胞癌发生于世界范围，尤其是我国等亚洲和非洲国家全球第六位的癌症和第三位最常见引起死亡的癌症全球第六位的癌症和第三位最常见引起死亡的癌症全球每年全球每年6060万人新诊断，中国占万人新诊断，中国占50%50%全球每年全球每年6060万人，中国每年万人，中国每年3030万人（万人（50%50%）死于肝癌）死于肝癌WorldwideIncidenceofHepatocellularCarcinomaHigh(>30:100,000)High(>30:100,000)Lowordataunavailable(<3:100,000)Lowordataunavailable(<3:100,000)Intermediate(3-30:100,000)Intermediate(3-30:100,000)WorldwideIncidenceofHepatocellularCarcinomaWorldwideIncidenceofHepatocellularCarcinomaHCCEpidemiologyHCCEpidemiologyEl-SeragHB,Gastroenterology2004El-SeragHB,Gastroenterology2004肝癌的全球发病情况瘤种新发病例（万）排名死亡病例（万）排名肺癌135.01118.01乳腺癌115.0241.15结直肠癌100.0352.94胃癌93.4470.02前列腺癌67.9522.16肝癌*62.6659.83ParkinDM,etal.CACancerJClin2005;55:74–108*包括HCC及胆管细胞癌（<10%）中国新发病例占中国新发病例占5555％，约％，约34.434.4万万2008年全国居民死亡原因调查恶性肿瘤的构成城市城市肺癌肺癌27.29%27.29%肝癌16.60%胃癌胃癌15.30%15.30%食管癌食管癌7.31%7.31%大肠癌大肠癌6.51%6.51%农村农村肝癌20.94%肺癌肺癌19.99%19.99%胃癌胃癌19.89%19.89%食管癌食管癌13.48%13.48%大肠癌大肠癌4.64%4.64%陈竺.全国第三次死因回顾抽样调查报告.中国协和医科大学出版社2008.1、肝癌的死亡率有上升趋势2、在男性的15-44、45-64年龄组和女性45-64年龄组，肝癌列癌症死亡原因第一位AdaptedfromIkedaK,etal,Hepatology1993AdaptedfromIkedaK,etal,Hepatology1993AdaptedfromIkedaK,etal,Hepatology1993AdaptedfromIkedaK,etal,Hepatology199300Yearsoffollow-upYearsoffollow-up%Cumulativeincidence%Cumulativeincidence202040406060001122334455667788991010HepatocellularCarcinomaHepatocellularCarcinomaHCCEpidemiologyHCCEpidemiologyWhyHCCisRising?WhyHCCisRising?•Risingincidenceofcirrhosis•HCV(mainreason)•HBV•Other(?NAFLD/insulinresistance)•Improvedsurvivalofpatientswithcirrhosis•Risingincidenceofcirrhosis•HCV(mainreason)•HBV•Other(?NAFLD/insulinresistance)•ImprovedsurvivalofpatientswithcirrhosisIncreasingprevalenceofpatientswithcirrhosisIncreasingprevalenceofpatientswithcirrhosisWhyHCCisRising?WhyHCCisRising?HCCEpidemiologyHCCEpidemiologyEl-SeragHB,Gastroenterology2004El-SeragHB,Gastroenterology2004三、病因1、病毒性肝炎中国HBV欧美、日本HCV2、肝硬化癌变发生率30-50%HCC合并Cirrhosis达50-90%3、肥胖和糖尿病4、黄曲霉毒素致癌物质5、其他亚硝胺类、偶氮苯类等RiskFactorsforHCCRiskFactorsforHCC•Cirrhosisfromanycause•HCV•HBV•Heavyalcoholconsumption•Non-alcoholicfattyliverdisease...