《2023国际肝癌协会肝细胞癌风险分层和监测白皮书》摘译
An excerpt from 2023 International Liver Cancer Association(ILCA)white paper on hepatocellular carcinoma risk stratification and surveillance
代维 1韩国宏1
作者信息
- 1. 西安国际医学中心医院消化内科,西安 710100
- 折叠
摘要
多数关于肝癌的研究致力于提高肝细胞癌监测的效力和有效性.与其他癌症一样,监测旨在早期诊断和根治性治疗,降低肝细胞癌相关病死率.肝细胞癌监测的证据支持源于一项乙型肝炎病毒感染患者的大型随机对照试验研究和几项肝硬化患者的队列研究.然而,在临床实践中,监测的有效性受限于各种阻碍,包括风险分层不恰当、实施力度不足、筛查工具准确性欠佳等.为解决这些问题,在此提出以下几个提议:开发新的风险分层算法和生物标志物以更好识别高危个体;加强监测策略的落实;开发灵敏度和特异度更高的影像学和血液学监测工具.新的监测策略不仅需要临床验证,还需要证实其临床实用性,即能否提高早癌的发现率,降低相关病死率.如上述问题得以解决,则可推进精准筛查模式,依据个体肝细胞癌风险制定监测策略,使监测价值最大化.然而,在设计和验证时,必须考虑到实际和协调安排问题.国际肝癌协会就以上问题于2022年6月举办了肝细胞癌风险分层和监测的单一主题研讨会.在此,特呈出这份白皮书,内容包括该领域的现状、正在进行的研究,以及新兴策略转化的阻碍.
Abstract
Major research efforts in liver cancer have been devoted to increasing the efficacy and effectiveness of surveillance for hepatocellular carcinoma(HCC).As with other cancers,surveillance programmes aim to detect tumors at an early stage,facilitate curative-intent treatment,and reduce cancer-related mortality.HCC surveillance is supported by a large randomized controlled trial in patients with chronic hepatitis B virus infection and several cohort studies in cirrhosis;however,effectiveness in clinical practice is limited by several barriers,including inadequate risk stratification,underuse of surveillance,and suboptimal accuracy of screening tests.There are several proposed strategies to address these limitations,including risk stratification algorithms and biomarkers to better identity at-risk individuals,interventions to increase surveillance,and emerging imaging-and blood-based surveillance tests with improved sensitivity and specificity for early HCC detection.Beyond clinical validation,data are needed to establish clinical utility,i.e.increased early tumor detection and reduced HCC-related mortality.If successful,these data could facilitate a precision screening paradigm in which surveillance strategies are tailored to individual HCC risk to maximise overall surveillance value.However,practical and logistical considerations must be considered when designing and implementing these validation efforts.To address these issues,the International Liver Cancer Association(ILCA)adjourned a single topic workshop on HCC risk stratification and surveillance in June 2022.Herein,we present a white paper on these topics,including the status of the field,ongoing research efforts,and barriers to the translation of emerging strategies.
关键词
癌,肝细胞/监测/风险分层/筛查/生物标志物Key words
Carcinoma,hepatocellular/Surveillance/Risk stratification/Screening/Biomarkers引用本文复制引用
出版年
2024
NETL
NSTL
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