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Hepatocellular Carcinoma - Challenges and Opportunities of a Multidisciplinary Approach [Working Title]最新文献

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Surgical Therapy of Hepatocellular Carcinoma: State of the Art Liver Resection 肝细胞癌的外科治疗:肝切除术的现状
S. Davakis, M. Vailas, Alexandros Kozadinos, P. Sakarellos, A. Karampa, D. Korkolis, G. Glantzounis, Alexandros Papalampros, E. Felekouras
Hepatocellular carcinoma (HCC) represents the third most common cause of cancer-related death, showing incremental growth rates throughout the last decades. HCC requires multidisciplinary approach in a group of patients suffering from underlying chronic liver disease, usually in the setting of cirrhosis. The mainstay of treatment in resectable cases is surgery, with anatomic and non-anatomic liver resections widely implemented, as well as liver transplantation in well-selected individuals. Nowadays, there is a variety of liver parenchyma transection devices used by hepatobiliary surgeons in specialized centers, which has significantly improved postoperative outcomes in HCC patients. Therefore, hepatectomy is considered safe and feasible and should be the main therapeutic option for HCC patients, candidates for resection. Liver resection utilizing cavitron ultrasonic aspirator in combination with bipolar radiofrequency ablation is safe and effective for the treatment of HCC with favorable clinical and oncological outcomes.
肝细胞癌(HCC)是癌症相关死亡的第三大常见原因,在过去几十年中呈现出递增的增长速度。肝细胞癌需要多学科联合治疗,治疗一组患有潜在慢性肝病的患者,通常伴有肝硬化。可切除病例的主要治疗方法是手术,解剖和非解剖性肝切除术广泛实施,以及在精心挑选的个体中进行肝移植。目前,专业中心的肝胆外科医生使用了多种肝实质横断装置,显著改善了HCC患者的术后预后。因此,肝切除术被认为是安全可行的,应该是HCC患者的主要治疗选择,是切除的候选者。空腔超声吸引器联合双极射频消融术治疗肝细胞癌安全有效,临床及肿瘤预后良好。
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引用次数: 0
Minimally Invasive Surgery for Hepatocellular Carcinoma; Latest Advances 肝细胞癌的微创手术治疗最新进展
A. Giakoustidis, A. Koffas, D. Giakoustidis, Vasileios N. Papadopoulos
Surgical resection is the gold standard for hepatocellular carcinoma management for early stages of the disease. With advances in technology and techniques, minimally invasive surgery provides a great number of advantages for these patients during their surgery and for their post-operative care. The selection of patients following a multi-disciplinary approach is of paramount importance. Adding to this, the developments in laparoscopic instruments and training, as well as the promising advantages of robotic surgery along with other forms of technology, increase the pool of patients that can undergo operation safely and with good results worldwide. We review results from great centres worldwide and delineate the accurate multi-disciplinary approach for this.
手术切除是肝细胞癌早期治疗的金标准。随着技术和技术的进步,微创手术为这些患者的手术过程和术后护理提供了许多优势。选择患者遵循多学科的方法是至关重要的。除此之外,腹腔镜设备和培训的发展,以及机器人手术和其他形式的技术的有前途的优势,增加了全世界可以安全接受手术并取得良好效果的患者数量。我们回顾了来自世界各地伟大中心的结果,并描绘了准确的多学科方法。
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引用次数: 0
Systemic Therapy in Hepatocellular Carcinoma 肝细胞癌的全身治疗
charonpongsuntorn Charonpongsuntorn
Systemic therapy of advanced stage hepatocellular carcinoma (HCC) was limited to the sorafenib in the past decade since 2007. Novel agents including multiple targeting agents, immune checkpoint inhibitors and anti-angiogenesis reported efficacy in treatment. This is the first time, the combination of atezolizumab and bevacizumab as first-line treatment is superior to sorafenib. Standard guideline in advanced HCC was changing. New novel drugs increase in available including multiple targeting agents and immune checkpoint blockade such as Lenvatinib, regorafenib, cabozantinib, ramucirumab and immunotherapy as first line or second line therapy will benefit in term of survival benefit and quality of life in advanced stage or unresectable hepatocellular carcinoma
自2007年以来,晚期肝细胞癌(HCC)的全身治疗在过去十年中仅限于索拉非尼。新型药物包括多靶点药物、免疫检查点抑制剂和抗血管生成报道了治疗效果。这是阿特唑单抗和贝伐单抗联合作为一线治疗首次优于索拉非尼。晚期HCC的标准治疗指南正在发生变化。新药物的增加,包括多靶向药物和免疫检查点阻断,如Lenvatinib, reorafenib, cabozantinib, ramucirumab和免疫疗法作为一线或二线治疗,将在晚期或不可切除的肝细胞癌的生存获益和生活质量方面受益
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引用次数: 0
Hepatitis B Virus (HBV) - Induced Hepatocarcinogenesis, a Founding Framework of Cancer Evolution & Development (Cancer Evo-Dev) 乙型肝炎病毒(HBV)诱导的肝癌发生,癌症进化与发展的基础框架(Cancer Evo-Dev)
Wenbin Liu, Guangwen Cao
In this chapter, we present the founding framework of a novel theory termed as Cancer Evolution-Development (Cancer Evo-Dev), based on the current understanding of hepatitis B virus (HBV) induced hepatocarcinogenesis. The interactions of genetic predispositions and HBV infection is responsible for the maintenance of chronic non-resolving inflammation. Under the inflammatory microenvironment, pro-inflammatory factors trans-activate the expression of cytidine deaminases and suppress the expression of uracil DNA glycosylase. The imbalance between the mutagenic forces and mutation-correcting forces facilitates the generations of somatic mutations, viral mutations, and viral integrations into the host genomes. The majority of cells with genomic mutations and mutated viruses are eliminated in survival competition. Only a small percentage of the mutated cells adapted to the hostile environment can survive, retro-differentiate, and function as cancer-initiating cells, representing a process of “mutation-selection-adaptation”. Cancer Evo-Dev lays the theoretical foundation for understanding the mechanisms by which chronic infection of HBV promotes hepatocarcinogenesis. This theory also plays an important role in specific prophylaxis, prediction, early diagnosis, and targeted treatment of cancers.
在本章中,我们基于目前对乙型肝炎病毒(HBV)诱导的肝癌发生的理解,提出了一种被称为癌症进化-发展(Cancer Evo-Dev)的新理论的基础框架。遗传易感性和HBV感染的相互作用是维持慢性非溶解性炎症的原因。炎症微环境下,促炎因子反式激活胞苷脱氨酶的表达,抑制尿嘧啶DNA糖基化酶的表达。诱变力和突变纠正力之间的不平衡促进了体细胞突变、病毒突变和病毒整合到宿主基因组中的发生。大多数具有基因组突变的细胞和突变病毒在生存竞争中被淘汰。在适应了恶劣环境的突变细胞中,只有一小部分能够存活、反向分化并发挥致癌细胞的功能,这是一个“突变-选择-适应”的过程。Cancer Evo-Dev为理解慢性HBV感染促进肝癌发生的机制奠定了理论基础。这一理论在癌症的特异性预防、预测、早期诊断和靶向治疗中也起着重要作用。
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引用次数: 0
Classification of Hepatocellular Carcinoma Using Machine Learning 使用机器学习的肝细胞癌分类
Lekshmi Kalinathan, Deepika Sivasankaran, Janet Reshma Jeyasingh, Amritha Sennappa Sudharsan, Hareni Marimuthu
Hepatocellular Carcinoma (HCC) proves to be challenging for detection and classification of its stages mainly due to the lack of disparity between cancerous and non cancerous cells. This work focuses on detecting hepatic cancer stages from histopathology data using machine learning techniques. It aims to develop a prototype which helps the pathologists to deliver a report in a quick manner and detect the stage of the cancer cell. Hence we propose a system to identify and classify HCC based on the features obtained by deep learning using pre-trained models such as VGG-16, ResNet-50, DenseNet-121, InceptionV3, InceptionResNet50 and Xception followed by machine learning using support vector machine (SVM) to learn from these features. The accuracy obtained using the system comprised of DenseNet-121 for feature extraction and SVM for classification gives 82% accuracy.
肝细胞癌(HCC)被证明是具有挑战性的检测和分期的主要原因是缺乏癌细胞和非癌细胞之间的差异。这项工作的重点是利用机器学习技术从组织病理学数据中检测肝癌分期。它的目标是开发一种原型,帮助病理学家以快速的方式提供报告并检测癌细胞的阶段。因此,我们提出了一个基于深度学习获得的HCC特征识别和分类系统,该系统使用VGG-16、ResNet-50、DenseNet-121、InceptionV3、InceptionResNet50和Xception等预训练模型,然后使用支持向量机(SVM)进行机器学习,从这些特征中学习。使用DenseNet-121进行特征提取,SVM进行分类,得到的准确率为82%。
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引用次数: 0
Hepatocellular Carcinoma: Diagnosis and Surveillance 肝细胞癌:诊断和监测
A. Kale
Hepatocellular carcinoma arises commonly on the background of liver cirrhosis. Patients presenting with clinical symptoms have advanced stage and often are unsuitable for curative therapies. Diagnosis of hepatocellular carcinoma is commonly performed by multiphase computed tomography (CT) and / or magnetic resonance imag¬ing scans (MRI). Contrast enhanced ultrasound and MRI with hepatobiliary contrast agents are better in characterizing small lesions. Tumor markers play an adjunct role in diagnosis. For HCC in cirrhotic liver biopsy is seldom required and diagnosis is based on typical imaging features of non-rim arterial phase hyperenhancement and washout on delayed phase and pseudocapsule appearance. This is due to differential blood supply of liver parenchyma, regenerative nodules and tumor. Biopsy is only required in noncirrhotic liver, vascular liver diseases, atypical imaging features. Surveillance programs involving high risk groups can help in early detection of lesions which are amenable for curative therapies. Biannual ultrasound with or without alfa fetoprotein are commonly used surveillance tests. Multidisciplinary teams provide platform for care coordination, reassessments of clinical course, and fine changes in treatment plans required for management of this complex group of patients.
肝细胞癌通常以肝硬化为背景。出现临床症状的患者已进入晚期,往往不适合治疗。肝细胞癌的诊断通常通过多相计算机断层扫描(CT)和/或磁共振成像扫描(MRI)进行。造影增强超声和MRI与肝胆对比剂对小病变的特征更好。肿瘤标志物在诊断中起辅助作用。对于肝硬化HCC,很少需要肝活检,诊断基于典型的非边缘动脉期高强化和延迟期和假包膜外观的冲洗。这是由于肝实质、再生结节和肿瘤的血供不同。只有在非肝硬化、血管性肝病、非典型影像学特征时才需要活检。涉及高风险人群的监测项目可以帮助早期发现病变,以便进行治疗。一年两次的超声检查(含或不含甲胎蛋白)是常用的监测检查。多学科团队为护理协调、临床过程的重新评估以及管理这一复杂患者群体所需的治疗计划的细微变化提供了平台。
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引用次数: 0
Treatment of Advanced Hepatocellular Carcinoma 晚期肝细胞癌的治疗
M. Aryan, Ellery Altshuler, Xia Qian, Wei Zhang
Hepatocellular Carcinoma (HCC) is the fifth most common cancer and represents the fourth most common cause of cancer related death worldwide. Treatment of HCC is dictated based upon cancer stage, with the most universally accepted staging system being the Barcelona Clinic Liver Cancer (BCLC) staging system. This system takes into account tumor burden, active liver function, and patient performance status. BCLC stage C HCC is deemed advanced disease, which is often characterized by preserved liver function (Child-Pugh A or B) with potential portal invasion, extrahepatic spread, cancer related symptoms, or decreased performance status. Sorafenib has been the standard treatment for advanced HCC over the past decade; however, its use is limited by low response rates, decreased tolerance, and limited survival benefit. Researchers and clinicians have been investigating effective treatment modalities for HCC over the past several years with a focus on systemic regimens, locoregional therapy, and invasive approaches. In this systemic review, we discuss the management of advanced HCC as well as the ongoing research on various treatment opportunities for these patients.
肝细胞癌(HCC)是世界上第五大常见癌症,也是导致癌症相关死亡的第四大常见原因。HCC的治疗取决于癌症分期,最普遍接受的分期系统是巴塞罗那临床肝癌(BCLC)分期系统。该系统考虑了肿瘤负荷、活动性肝功能和患者的表现状况。BCLC C期HCC被认为是晚期疾病,其特征通常是肝功能保留(Child-Pugh A或B),伴有潜在的门静脉侵犯、肝外扩散、癌症相关症状或功能状态下降。在过去的十年中,索拉非尼一直是晚期HCC的标准治疗;然而,由于反应率低、耐受性降低和生存获益有限,其使用受到限制。在过去的几年里,研究人员和临床医生一直在研究HCC的有效治疗方式,重点是全身方案、局部治疗和侵入性方法。在这篇系统综述中,我们讨论了晚期HCC的管理以及这些患者的各种治疗机会的正在进行的研究。
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引用次数: 0
Multimodal Imaging of Hepatocellular Carcinoma Using Dynamic Liver Phantom 肝细胞癌的动态肝影多模态成像
Muntaser S. Ahmad, Osama Makhamrah, M. Hjouj
Liver phantom is used at various medical levels, such as detecting hepatocellular carcinoma (HCC) in the early stages, training medical staff to deal with HCC by taking biopsies, developing new sequences on medical imaging devices, confirming the image quality, applying treatments to HCC, and others. All of the trials should be applied before entering the real human body. The phantom includes properties very similar to those of the human body, as well as the properties of liver cancer and how it is treated within the body through its biological form. Therefore, the present chapter aims to provide comprehensive information to consider when fabricating HCC-containing phantoms and the characteristics of those phantoms in proportion to multimodal medical imaging to aid in understanding the main target of dynamic phantom for HCC.
肝幻像应用于各种医疗层面,如早期检测肝细胞癌(HCC)、通过活检培训医务人员处理HCC、在医学成像设备上开发新序列、确认图像质量、应用HCC治疗等。所有的试验都应该在进入真正的人体之前应用。幻影包括与人体非常相似的特性,以及肝癌的特性以及如何通过其生物形式在体内治疗。因此,本章旨在提供综合信息,以考虑在制造含HCC的幻像时,以及这些幻像的特征与多模态医学成像的比例,以帮助理解HCC动态幻像的主要目标。
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引用次数: 4
Research Frontier of Accurate Diagnosis and Treatment Guided by Molecular Typing of Hepatocellular Carcinoma 肝细胞癌分子分型指导下准确诊治的研究前沿
Haicaho Zhao, Changzhou Chen, Jiefeng He
Liver cancer will continue to be a major disease threatening the lives and health of our people in the next few decades. In recent years, with the development of early diagnosis and treatment of liver cancer, precise liver resection, and the development of targeted and immunotherapeutic drugs, the survival rate of liver cancer patients has been improved. Nevertheless, due to the high heterogeneity of liver cancer, patients with liver cancer in the same clinical stage still have great differences in response to treatment and prognosis. New staging and classification indicators are urgently needed to facilitate accurate diagnosis and treatment of liver cancer, so as to further improve the survival rate of patients. The continuous progress and development of multi-omics technology, single-cell technology, tumor molecular visualization technology and medical artificial intelligence, etc., make the molecular classification of liver cancer more and more approaching the true nature of tumor biological characteristics, thus contributing to the accurate diagnosis and treatment of liver cancer.
肝癌在今后几十年仍将是威胁我国人民生命健康的主要疾病。近年来,随着肝癌的早期诊断和治疗的发展,肝脏的精确切除,以及靶向和免疫治疗药物的发展,肝癌患者的生存率得到了提高。然而,由于肝癌的高度异质性,处于同一临床阶段的肝癌患者在治疗反应和预后方面仍存在较大差异。迫切需要新的分期和分类指标,以方便肝癌的准确诊断和治疗,从而进一步提高患者的生存率。多组学技术、单细胞技术、肿瘤分子可视化技术、医学人工智能等的不断进步和发展,使肝癌的分子分类越来越接近肿瘤生物学特征的真实本质,从而有助于肝癌的准确诊断和治疗。
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引用次数: 0
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Hepatocellular Carcinoma - Challenges and Opportunities of a Multidisciplinary Approach [Working Title]
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