切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (01): 22 -28. doi: 10.3877/cma.j.issn.2095-3232.2023.01.005

专家论坛

肝细胞癌早期诊断和筛查
丁成明1, 侯嘉丰1, 陶光伟1, 齐硕1, 谢翼1, 冯灿1, 陈振坤1, 蒋心渺1, 邓鑫1, 彭健2,()   
  1. 1. 421001 湖南省衡阳市南华大学附属第一医院肝胆胰外科
    2. 410008 湖南省长沙市中南大学湘雅医院老年病科老年外科 国家老年疾病临床医学研究中心(湘雅)
  • 收稿日期:2022-09-21 出版日期:2023-02-10
  • 通信作者: 彭健
  • 基金资助:
    湖南省科技厅临床医疗技术创新引导项目(2020SK5181); 湖南省卫生健康委员会临床医学研究专项课题(20201950)

Early diagnosis and screening of hepatocellular carcinoma

Chengming Ding1, Jiafeng Hou1, Guangwei Tao1   

  • Received:2022-09-21 Published:2023-02-10

原发性肝癌(肝癌)包括肝细胞癌(HCC)、肝内胆管细胞癌(ICC)和混合型3种,其中HCC占85%~90%[1]。肝癌具有较高的发病率,居全球恶性肿瘤的第6位,而中国肝癌患者约占全世界肝癌患者的50%左右,且发病率呈现不断上升趋势[2]。此外,肝癌病死率亦居高不下,其5年生存率仅为10%左右,居中国常见恶性肿瘤致死率的第2位[3]。究其原因为肝癌起病隐匿,疾病进展快,初期常很难发现,确诊时基本已发展至中晚期。实现肝癌的早期发现、精准诊断、根治性治疗,是有效提高肝癌患者5年生存率及生活质量的重要手段。本文总结和分析了近年多种HCC早期诊断方法,旨在为HCC早期诊疗提供临床依据。

[1]
Huang TE, Deng YN, Hsu JL, et al. Evaluation of the anticancer activity of a bile acid-dihydroartemisinin hybrid ursodeoxycholic-dihydroartemisinin in hepatocellular carcinoma cells[J]. Front Pharmacol, 2020(11):599067.
[2]
Fitzmaurice C, Abate D, Abbasi N, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2019, 5(12):1749-1768.
[3]
郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2019, 41(1):19-28.
[4]
Park YN, Kim MJ. Hepatocarcinogenesis: imaging-pathologic correlation[J]. Abdominal Imaging, 2011, 36(3):232-243.
[5]
Aihara T, Noguchi S, Sasaki Y, et al. Clonal analysis of regenerative nodules in hepatitis C virus-induced liver cirrhosis[J]. Gastroenterology, 1994, 107(6):1805-1811.
[6]
Park YN. Update on precursor and early lesions of hepatocellular carcinomas[J]. Arch Pathol Lab Med, 2011, 135(6):704-715.
[7]
International Consensus Group for Hepatocellular Neoplasia. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia[J]. Hepatology, 2009, 49(2):658-664.
[8]
Galle PR, Foerster F, Kudo M, et al. Biology and significance of alpha-fetoprotein in hepatocellular carcinoma[J]. Liver Int, 2019, 39(12):2214-2229.
[9]
Hsia CY, Huo TI, Chiang SY,et al. Evaluation of interleukin-6, interleukin-10 and human hepatocyte growth factor as tumor markers for hepatocellular carcinoma[J]. Eur J Surg Oncol, 2007, 33(2):208-212.
[10]
Yi X, Yu S, Bao Y. Alpha-fetoprotein-L3 in hepatocellular carcinoma: a meta-analysis[J]. Clin Chim Acta, 2013(425):212-220.
[11]
Zheng Q, Bao C, Guo W, et al. Circular RNA profiling reveals an abundant circHIPK3 that regulates cell growth by sponging multiple miRNAs[J]. Nat Commun, 2016(7):11215.
[12]
Ren S, Xin Z, Xu Y, et al. Construction and analysis of circular RNA molecular regulatory networks in liver cancer[J]. Cell Cycle, 2017, 16(22):2204-2211.
[13]
王婷, 吴文晓, 马全涛, 等. 肝癌早期诊断标志物的研究进展[J]. 中国药事, 2020, 34(3):349-356.
[14]
Xing H, Zheng YJ, Han J, et al. Protein induced by vitamin K absence or antagonist-Ⅱ versus alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: a systematic review with meta-analysis[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(6):487-495.
[15]
国家卫生健康委员会. 原发性肝癌诊疗规范(2019年版)[J]. 临床肝胆病杂志, 2020, 36(2):277-292.
[16]
Best J, Bilgi H, Heider D, et al. The GALAD scoring algorithm based on AFP, AFP-L3, and DCP significantly improves detection of BCLC early stage hepatocellular carcinoma[J]. Z Gastroenterol, 2016, 54(12):1296-1305.
[17]
Xu WJ, Guo BL, Han YG, et al. Diagnostic value of alpha-fetoprotein-L3 and Golgi protein 73 in hepatocellular carcinomas with low AFP levels[J]. Tumor Biol, 2014, 35(12):12069-12074.
[18]
刘毓键, 马明洋. 血清标志物在肝细胞肝癌早期诊断中的研究进展及应用前景[J]. 医学综述, 2020, 26(7):1325-1330, 1336.
[19]
Xu D, Su C, Sun L, et al. Performance of serum glypican 3 in diagnosis of hepatocellular carcinoma: a meta-analysis[J]. Ann Hepatol, 2019, 18(1):58-67.
[20]
Zhu M, Zheng J, Wu F, et al. OPN is a promising serological biomarker for hepatocellular carcinoma diagnosis[J]. J Med Virol, 2020, DOI: 10.1002/jmv.25704[Epub ahead of print].
[21]
Fezza M, Moussa M, Aoun R, et al. DKK1 promotes hepatocellular carcinoma inflammation, migration and invasion: implication of TGF-β1[J]. PLoS One, 2019, 14(9):e0223252.
[22]
Shen Q, Fan J, Yang XR, et al. Serum DKK1 as a protein biomarker for the diagnosis of hepatocellular carcinoma: a large-scale, multicentre study[J]. Lancet Oncol, 2012, 13(8):817-826.
[23]
Zhou JYu LGao X,et al. Plasma microRNA panel to diagnose hepatitis B virus-related hepatocellular carcinoma[J]. J Clin Oncol201129(36):4781-4788.
[24]
Peng C, Ye Y, Wang Z, et al. Circulating microRNAs for the diagnosis of hepatocellular carcinoma[J]. Dig Liver Dis, 2019, 51(5):621-631.
[25]
Peng W, Fan H. Long non-coding RNA PANDAR correlates with poor prognosis and promotes tumorigenesis in hepatocellular carcinoma[J]. Biomed Pharmacother, 2015(72):113-118.
[26]
El-Tawdi AH, Matboli M, El-Nakeep S, et al. Association of long noncoding RNA and c-JUN expression in hepatocellular carcinoma[J]. Expert Rev Gastroenterol Hepatol, 2016, 10(7):869-877.
[27]
Yuan W, Sun Y, Liu L, et al. Circulating lncRNAs serve as diagnostic markers for hepatocellular carcinoma[J]. Cell Physiol Biochem, 2017, 44(1):125-132.
[28]
Ignatiadis M, Dawson SJ. Circulating tumor cells and circulating tumor DNA for precision medicine: dream or reality?[J]. Ann Oncol, 2014, 25(12):2304-2313.
[29]
Huang AZhang XZhou SL,et al. Detecting circulating tumor DNA in hepatocellular carcinoma patients using droplet digital PCR is feasible and reflects intratumoral heterogeneity[J]. J Cancer20167(13):1907-1914.
[30]
Huang AZhao XYang XR,et al. Circumventing intratumoral heterogeneity to identify potential therapeutic targets in hepatocellular carcinoma[J]. J Hepatol201767(2):293-301.
[31]
Wen LLi JGuo H,et al. Genome-scale detection of hypermethylated CpG islands in circulating cell-free DNA of hepatocellular carcinoma patients[J]. Cell Res201525(11):1250-1264.
[32]
Xu RHWei WKrawczyk M,et al. Circulating tumour DNA methylation markers for diagnosis and prognosis of hepatocellular carcinoma[J]. Nat Mater, 2017, 16(11):1155-1161.
[33]
Cai J, Chen L, Zhang Z, et al. Genome-wide mapping of 5-hydroxymethylcytosines in circulating cell-free DNA as a non-invasive approach for early detection of hepatocellular carcinoma[J]. Gut, 2019, 68(12):2195-2205.
[34]
Sepideh A, Karim P, Hossein A, et al. Effects of multistrain probiotic supplementation on glycemic and inflammatory indices in patients with nonalcoholic fatty liver disease: a double-blind randomized clinical trial[J]. J Am Coll Nutr, 2016, 35(6):500-505.
[35]
Ren Z, Li A, Jiang J, et al. Gut microbiome analysis as a tool towards targeted non-invasive biomarkers for early hepatocellular carcinoma[J]. Gut, 2019, 68(6):1014-1023.
[36]
Palmer WC, Patel T. Are common factors involved in the pathogenesis of primary liver cancers? a meta-analysis of risk factors for intrahepatic cholangiocarcinoma[J]. J Hepatol, 2012, 57(1):69-76.
[37]
Kitao A, Matsui O, Yoneda N, et al. The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid enhanced MR imaging[J]. Eur Radiol, 2011, 21(10):2056-2066.
[38]
Bota S, Piscaglia F, Marinelli S, et al. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma[J]. Liver Cancer, 2012, 1(3/4):190-200.
[39]
European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol, 2012, 56(4):908-943.
[40]
Sangiovanni A, Manini MA, Iavarone M, et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis[J]. Gut, 2010, 59(5):638-644.
[41]
Okada M, Imai Y, Kim T, et al. Comparison of enhancement patterns of histologically confirmed hepatocellular carcinoma between gadoxetate- and ferucarbotran-enhanced magnetic resonance imaging[J]. J Magn Reson Imaging, 2010, 32(4):903-913.
[42]
Lee DH, Lee JM, Baek JH, et al. Diagnostic performance of gadoxetic acid-enhanced liver MR imaging in the detection of HCCs and allocation of transplant recipients on the basis of the Milan criteria and UNOS guidelines: correlation with histopathologic findings[J]. Radiology, 2015, 274(1):149-160.
[43]
Kim YS, Song JS, Lee HK, et al. Hypovascular hypointense nodules on hepatobiliary phase without T2 hyperintensity on gadoxetic acid-enhanced MR images in patients with chronic liver disease: long-term outcomes and risk factors for hypervascular transformation[J]. Eur Radiol, 2016, 26(10):3728-3736.
[44]
Park MS, Kim S, Patel J, et al. Hepatocellular carcinoma: detection with diffusion-weighted versus contrast-enhanced magnetic resonance imaging in pretransplant patients[J]. Hepatology, 2012, 56(1):140-148.
[1] 任芸芸. 无创产前诊断时代早孕期超声检查的价值[J]. 中华医学超声杂志(电子版), 2022, 19(09): 873-876.
[2] 曾晴, 文华轩, 袁鹰, 丁妍, 罗丹丹, 廖伊梅, 梁美玲, 秦越, 彭桂艳, 林毅, 邹于, 李胜利. 二维横切面新方法对胎儿胼胝体结构异常的诊断价值[J]. 中华医学超声杂志(电子版), 2022, 19(09): 899-907.
[3] 杜婷婷, 付颖, 曾兰, 崔立刚, 黄九平, 薛恒. 常规超声及超声造影对局灶性胸膜增厚病变的鉴别诊断价值[J]. 中华医学超声杂志(电子版), 2022, 19(08): 748-753.
[4] 付颖, 崔立刚, 杜婷婷, 谭石, 王淑敏, 孙彦, 马久祎. 常规超声及超声造影鉴别诊断局灶性机化性肺炎与非特异性肺炎的初步研究[J]. 中华医学超声杂志(电子版), 2022, 19(08): 754-760.
[5] 付泽辉, 卢叶君, 张剑, 莫晓民, 贺烨, 张晓青, 陶楚楚, 陈卉. 常规超声特征联合内部粗大钙化特征鉴别甲状腺结节良恶性的价值[J]. 中华医学超声杂志(电子版), 2022, 19(08): 767-773.
[6] 武玺宁, 张培培, 欧阳云淑, 张一休, 姜玉新, 李建初, 孟华. 基于标准切面培训的教学法在住院医师产前超声病例诊断中的应用[J]. 中华医学超声杂志(电子版), 2022, 19(07): 712-715.
[7] 黄兴锋, 宋浩, 高凌. 肝恶性纤维组织细胞瘤32例手术体会[J]. 中华普外科手术学杂志(电子版), 2023, 17(01): 114-116.
[8] 杨星飞, 张鹏, 李兰军, 马光辉, 胡培良, 杜同海, 孙振卿. 两种不同取栓方法在肝细胞癌伴胆管癌栓中的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(01): 36-39.
[9] 秦国强, 卢旭, 张朝枫, 罗欣, 李杰贤, 邹戈, 江福能. 超声造影经直肠前列腺靶向穿刺活检术在PSA 4~10 ng/ml患者中的作用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(01): 36-38.
[10] 刘红枝, 刘景丰. 大数据和人工智能在原发性肝癌筛查与诊断中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 1-5.
[11] 元云飞. 肝癌转化治疗后外科切除的必要性和手术时机[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 11-15.
[12] 方诚, 夏勇, 沈锋. 不可切除肝内胆管细胞癌转化治疗策略[J]. 中华肝脏外科手术学电子杂志, 2022, 11(06): 537-541.
[13] 周辉年, 李玉民. 肝癌转化治疗[J]. 中华肝脏外科手术学电子杂志, 2022, 11(06): 542-547.
[14] 牛逸凡, 马晓娟. 经静脉超声造影在剖宫产瘢痕部位妊娠诊断及鉴别诊断中的应用进展[J]. 中华临床医师杂志(电子版), 2022, 16(08): 801-804.
[15] 蒋亦林, 伍刚, 刘波, 沈洁, 刘如恩. 继发性三叉神经痛诊疗策略[J]. 中华临床医师杂志(电子版), 2022, 16(07): 643-646.
阅读次数
全文


摘要