我国原发性肝癌筛查的现状、挑战及发展方向
Current status,challenges and future directions for hepatocellular carcinoma surveillance in China
姜绍文 1周惠娟 1谢青1
作者信息
- 1. 上海交通大学医学院附属瑞金医院感染科,上海 200001
- 折叠
摘要
2020年,全球原发性肝癌是第6位最常见的恶性肿瘤,全球新诊断病例90.57万,而由原发性肝癌导致的死亡率高居恶性肿瘤致死第3位,合计约83万,总体死亡率为8.7/10万.2020年,亚洲地区新增原发性肝癌65.7万例,死亡60.9万例,分别占全球的72.5%、73.3%.2020年,我国新增原发性肝癌患者41万例,死亡39.1万例,死亡率为17.2/10万,高居恶性肿瘤致死的第2位.全球每年近半数的原发性肝癌新发病例及死亡病例发生在我国,疾病负担沉重.肝细胞癌(hepatocellular carcinoma,HCC)占原发性肝癌的75%～85%.我国的HCC患者由于确诊时大多处于中晚期,年龄标化的5年生存率仅为14.1%,预后极差.HCC早诊率低是导致患者治疗效果差的重要原因之一,而提高HCC早诊率的关键在于进行有效的HCC筛查.传统的"腹部超声+血甲胎蛋白检测"的筛查手段,远不能满足临床筛查早期HCC的需求,存在筛查执行率低、对早期HCC筛查的灵敏度低、肝癌基础病因变化对HCC筛查形成了新的挑战等问题.为优化HCC筛查效果、改善患者预后,应对策略需从患者及医护等多角度入手提高HCC筛查的执行率,开发准确率更高、便捷性更好的新型HCC筛查手段[如GALAD(gender,age,AFP-L3,DCP,AFP)评分、液体活检等],提倡"个体化"筛查的策略,分层富集和精准筛查,优化医疗资源使用的成本效益比.作为个体化筛查策略之一的"数字化"赋能闭环肝病精细化管理及HCC筛查是创新模式,也是我国管理应对策略的选择之一.
Abstract
In 2020,primary liver cancer ranked as the sixth most common malignancy worldwide,with 905 700 newly-diagnosed cases,and 830 000 deaths with an overall mortality rate of 8.7/100 000,ranking third in in malignant tu-mors.In Asia,there were 657 000 newly-diagnosed cases and 609 000 deaths,accounting for 72.5%and 73.3%of the global burden,respectively.In China,primary liver cancer is one of the most common malignant tumors,with 410 000 new cases,and 391000 deaths with a mortality rate of 17.2/100 000,ranking the second highest among the causes of cancer deaths.Approximately half of annual global newly-diagnosed cases and deaths of liver cancer occurred in China,leading to an extremely heavy disease burden.Hepatocellular carcinoma(HCC)accounts for 75%-85%of primary liver cancer.The 5-year survival rate of HCC patients is merely 14.1%in China,mainly due to advanced disease stage at the diagnosis in most HCC patients.The low rate of diagnosis of early-stage HCC is one of the most important reasons for the poor treatment out-come of HCC patients.The key to improving the diagnosis of early-stage HCC lies on the effective HCC surveillance.The current surveillance method of"abdominal ultrasound+alpha-fetoprotein"is far from meeting the clinical needs in detect-ing early-stage HCC,which is faced with many problems,including low implementation rates of HCC screening,poor sensi-tivity for early-stage HCC,and new challenges posed by profound changes in the underlying etiologies of hepatocellular car-cinoma in the past decade.In order to optimize the efficacy of HCC surveillance and improve the prognosis of HCC pa-tients,we must adopt effective strategies,raise the implementation rate of HCC surveillance from the perspectives of pa-tients and healthcare professionals,develope new HCC surveillance tools of higher accuracy and with more convenience,[GALAD(gender,age,AFP-L3,DCP,AFP)score and liquid biopsy];advocating"individualized"surveillance strategies,stratified enrichment and precise screening to maximize the cost-effectiveness of healthcare resources.As one innovative model for individualized HCC surveillance,"artificial intelligence"in closed-loop precise liver disease management may serve as a strategic choice for disease management in China.
关键词
肝癌/筛查/早期诊断/挑战/应对策略Key words
Hepatocellular carcinoma/Surveillance/Early detection/Challenges/Coping strategies引用本文复制引用
基金项目
国家自然科学基金青年基金(82070604)
国家自然科学基金青年基金(82270618)
上海市临床重点专科建设项目(shslczdzk01103)
出版年
2024
国家科技期刊平台
NSTL
万方数据