To improve the prognosis of liver cancer, these points must be grasped

Recently, the team of academician Wang Xuehao of the Hepatobiliary Center of Jiangsu Provincial People's Hospital compiled the surgical treatment experience of liver cancer into an article - "Analysis of Exceptional Treatment of Primary Liver Cancer 10966", published in the Chinese Journal of Surgery. Through exhaustive data analysis, the authors concluded in the article that the long-term survival rate of liver cancer patients after surgical treatment has improved significantly in the past 10 years. Taking Jiangsu Provincial People's Hospital as an example, the survival rate of liver cancer patients after surgical treatment has increased from 32.9% in the early stage to 60% in the past 10 years.

The article analyzes that the improvement of patient survival rate is mainly due to the establishment of liver cancer early screening system, the advancement of surgical technology, and the development of comprehensive treatment of liver cancer. The authors also point out that this means that in the face of liver cancer, patients no longer have to "talk about cancer discoloration" again.

1

Breakthrough in the diagnosis and treatment of liver cancer: high-risk groups must be screened early and diagnosed early

The most common cause of liver cancer is hepatitis B virus infection. The pathogenesis characteristics of liver cancer patients in mainland China mostly follow the progressive pattern of hepatitis-cirrhosis-liver cancer. About 75% of patients with liver cancer have a history of hepatitis B. Factors that cause liver cancer also include hepatitis C virus infection, alcohol consumption, fatty liver disease, eating moldy foods, and mistakenly taking Traditional Chinese medicine containing aristolochia bells.

According to data released by the World Health Organization's International Agency for Research on Cancer (IARC), there were 410,000 new cases of liver cancer in mainland China in 2020, including 390,000 deaths. The main reasons are: first, the screening of high-risk groups is not universal, the early diagnosis rate is low, 70% to 80% of patients are already in the middle and advanced stages of diagnosis; the second is that the early clinical symptoms of liver cancer are hidden, abdominal pain, bloating, jaundice and other symptoms, most of which do not appear until the middle and late stages of the disease; third, most patients have a history of hepatitis B or C cirrhosis and underlying diseases, and have poor ability to tolerate surgery and drug treatment.

Early detection of liver cancer is crucial. The 5-year survival rate of patients with early liver cancer after surgery can reach about 80%. For high-risk groups with a family history of hepatitis B, hepatitis C, cirrhosis, obesity, fatty liver, and liver cancer, timely screening to prevent the disease from chronic inflammation to malignant diseases and block the process of cancer is an effective solution to the challenge of liver cancer.

Alpha-fetoprotein is an important examination item for early screening, early diagnosis and efficacy monitoring of liver cancer. For the above-mentioned high-risk groups, they should regularly go to the liver surgery clinic to check for liver cancer, it is recommended to check alpha-fetoprotein every six months, do liver B ultrasound, and recommend liver CT, MRI and liver B ultrasound interval.

2

Pinpoint the direction of liver cancer surgery: hepatic resection is still the preferred treatment

At present, there are many surgical methods for liver cancer. Once the patient has been examined for liver occupancy, he or she must first go to the liver surgery department to determine whether it is liver cancer and whether surgical treatment is feasible. If it is a medium-term and advanced stage, it cannot be operated on temporarily, and interventional, immune, targeted therapy can be practiced, and after several courses of comprehensive treatment, the tumor will be reduced before surgery. Advanced liver cancer can be treated with immunotherapy, and combined interventional, targeted, radiotherapy and other therapies can be considered according to liver function and other conditions to prolong the patient's life and improve the quality of life. The latest research progress shows that immunotherapy and targeted therapy have shown good results in the middle and advanced treatment of liver cancer.

Surgery for liver cancer can be performed with liver resection and liver transplantation. According to the study of the Hepatobiliary Center of Jiangsu Provincial People's Hospital, if the patient is suitable for both liver transplantation and liver resection, considering the lack of donor liver, hepatectomy is recommended. After liver cancer is removed, patients should be closely followed up, and if they recur, liver transplantation can be performed again. Studies have shown that the overall survival rate of patients with this type of remedial liver transplant is comparable to that of patients undergoing a stage I liver transplant.

It should be noted that liver resection surgery should retain as much of the remaining liver volume as possible under the premise of ensuring negative margins, so as to provide sufficient liver function reserves for comprehensive treatment such as interventional therapy, immunotherapy and targeted therapy after the recurrence of liver cancer.

3

Cracking the relapse problem: immune neoadjuvant therapy can be expected

In the past 10 years, the 5-year survival rate of liver cancer patients treated by surgery has been significantly improved, but the recurrence rate of liver cancer patients with resectable liver cancer in stage IIb and IIIa is still more than 55% after surgery, which seriously affects the long-term survival of patients. How to reduce the high postoperative recurrence rate of these patients has become a "difficult point" in the treatment of liver cancer. At this point, immunocompetent therapy enters the team's field of vision.

Adjuvant immunotherapy refers to the use of immune checkpoint inhibitors, such as PD1/PD-L1 monoclonal antibody or CTLA-4 monoclonal antibody, before surgery to reduce the recurrence rate after surgery and improve long-term survival. As an emerging treatment method, the preoperative use of immunocompetent therapy has achieved initial results in the treatment of malignant tumors such as non-small cell lung cancer and melanoma, but there are still few research in the field of liver cancer. At the end of 2019, Academician Wang Xuehao's team carried out a clinical trial of "single-arm phase II immune neoadjuvant therapy before resectable hepatocellular carcinoma". The results of the trial showed that with preoperative immunocompetitive therapy for liver cancer, the recurrence rate of patients in one year after surgical removal of liver cancer was reduced to 45%, and the tolerance was good, safe and reliable. The research results were published in the Journal of Cancer Immunotherapy, an international journal for tumor immunotherapy, which opened up new ideas for new adjuvant therapy for liver cancer immunology.

After years of efforts, we have conducted in-depth research on the occurrence and development of liver cancer, as well as the laws, mechanisms and mechanisms of metastasis and recurrence after surgery. The number of liver cancer patients who survive more than 5 years and 10 years after surgery has also increased significantly. If we can achieve early detection and early prevention, and everyone develops healthy living and eating habits, I believe that in the future, we will no longer "talk about cancer discoloration".

Author: Wang Xuehao, academician of the Chinese Academy of Engineering

Finishing: He Yutian Xia Yongxiang

Planner: Fang Tong

Editor: Wang Jianying