Abstract:Shen Feng was also hired as the editor-in-chief of the 9th edition of Huang Jiasi Surgery, becoming one of the three most authoritative and influential editors-in-chief of scientific classics in the field of surgery in mainland China.
In the field of international hepatobiliary surgery, the name "China Shen" is shining enough:
As an explorer, he has established the theory and technical system of precision treatment for intrahepatic cholangiocarcinoma, leading the further improvement of the diagnosis and treatment level at home and abroad. As a pioneer, he took the lead in proposing treatment based on biological characteristics and breaking through key technologies, opening up a new way of precision treatment for liver cancer. As a pioneer, he created a full-chain precision treatment decision-making system for hepatobiliary tumor recurrence, providing a "Chinese solution" for recurrence prevention. Shen Feng, the Third Affiliated Hospital of the Naval Medical University, is affectionately known as "China Shen" by his international counterparts.
5 scientific research results have been rewritten into international authoritative guidelines
Innovation for the people is a true portrayal of Shen Feng's medical research life. Over the past 39 years, he has been committed to the research on the treatment and decision-making system of hepatobiliary tumors, a major malignant disease in mainland China, and has always been at the forefront of the world's hepatobiliary field.
"The process of being a healer is exactly the process of an ascetic, and before becoming a healer, the first person who needs to be healed should be ourselves. Before all is given, let's become a 'have' person. This passage is Shen Feng's original intention of innovating for the people.
Intrahepatic cholangiocarcinoma is internationally recognized as a refractory disease with extremely poor efficacy and an increasing incidence. The lack of individualized staging seriously restricts the precise treatment decision of intrahepatic cholangiocarcinoma, and there is a competition in the world to study it.
In 2008, through a 10-year large-sample cohort study, Shen Feng identified 7 clinicopathological factors significantly related to the biological characteristics and prognosis of intrahepatic cholangiocarcinoma, and constructed a nomogram that predicted the prognosis of individuals, forming an individualized staging of intrahepatic cholangiocarcinoma, which was 11 months earlier than the individualized staging proposed in the West, and the clinical application confirmed that the new staging accurately guided clinical treatment decisions, and increased the 5-year survival rate by 15.1%.
Jarnagin, president of the American Hepatobiliary and Pancreatic Association, validated the new staging in patients at the prestigious Memorial Sloan Kettering Cancer Center, reporting that it is "the most accurate and well applicable to Western patients." Verification was carried out by 12 centers in Europe and the United States, including Johns Hopkins University, and it was reported as "the only staging criterion that clearly distinguishes prognosis". The Japanese liver cancer research team, which is composed of top multidisciplinary experts in Japan, commented that it is "better than Japanese staging with precise design". This staging has made a major revision of the international classic "tumor-lymph node-metastasis" staging, and has been popularized and applied to the study of 52 other diseases, which is internationally known as the "Chinese nomogram".
"Our research has been developed little by little with the sincere teachings and strong support of our mentor, Academician Wu Mengchao. Shen Feng said that Wu Lao taught by example and worked hard to promote the clinical research of hepatobiliary surgery in the mainland.
Under the leadership of Shen Feng, his team has done a lot of solid and hard work in patient treatment, follow-up, clinical research analysis, etc. Shen Feng inherited and carried forward the "Four Brave (Yong) Spirit" of Academician Wu Mengchao of "bravely entering the forbidden area, bravely climbing the peak, never satisfied, and always striving to be the first", and led his team to advance to the forefront of the international hepatobiliary field day and night. On the basis of staging research, Shen Feng's team performed the largest number of intrahepatic cholangiocarcinoma surgeries in the world (more than 4,100 cases), and further discovered that the etiology and histological classification of intrahepatic cholangiocarcinoma also have important individualized treatment guidance value. The technical gaps such as targeted therapy for advanced intrahepatic cholangiocarcinoma have solved the core problems from discovery to treatment of intrahepatic cholangiocarcinoma, and constructed an individualized surgical diagnosis and treatment system for intrahepatic cholangiocarcinoma.
Shen Feng led the team to do a lot of solid and arduous research work. Courtesy of the Third Affiliated Hospital of the Naval Medical University
In terms of mechanism, he revealed that the joint activation of Hippo and Wnt pathways leads to the invasion and metastasis of intrahepatic cholangiocarcinoma, which provides an important basis for further development of interventions to inhibit invasion and metastasis. J Hepatol, a leading international academic journal in the field of liver diseases, described his research as a "perfect case". In recognition of his important academic contributions, the prestigious academic journal The Lancet Oncology invited him to review the clinical trial results of the world's first specific targeted drug for cholangiocarcinoma and to publish a review of progress in this field.
The research results of Shen Feng's team have increased the 5-year survival rate of patients with intrahepatic cholangiocarcinoma from 20.5% to 35.2% after surgery, which has been cited by a large number of literature and journals at home and abroad as the best curative effect of the disease, forming the first "Chinese Expert Consensus on the Surgical Treatment of Intrahepatic Cholangiocarcinoma", and 18 scientific research results have been incorporated into international diagnosis and treatment guidelines and widely used, of which 5 have rewritten the European Association for the Study of the Liver (EASL) and other international authoritative guidelines may fill the gaps, and have made pioneering contributions to establishing China's international leading position in the diagnosis and treatment of intrahepatic cholangiocarcinoma.
Breakthroughs in key technologies open up new ways of precision treatment of liver cancer
On November 3, 2020, Shen Feng won the Ho Leung Ho Lee Foundation Science and Technology Progress Award, and was the only winner in the field of medicine in Shanghai that year.
Shen Feng said that despite the increase in liver cancer treatment methods and technological advances, the overall efficacy has not been significantly improved, so he will take more accurate and individualized treatment selection as the research direction to achieve both improving the efficacy and reducing the treatment trauma and medical costs of patients. He found that liver cancer forms microvascular invasion through mechanisms such as the increase in the proportion of CD133 + CD44+ cells and the activation of glutamic acid β hydroxylase, which reflects the invasive biological characteristics, and further found that the treatment with strong ability to clear microvascular invasion has good cure, but the treatment with large trauma and slightly weaker clearance ability can also achieve good results for patients with negative microvascular invasion, so he innovatively proposed to select treatment based on microvascular invasion.
In order to overcome the difficulty that microvascular invasion can only be diagnosed in postoperative pathology and cannot be predicted before surgery, he created an individualized prediction model for preoperative microvascular invasion, and accurately selected resection, ablation or liver transplantation and other treatments according to the predicted risk of microvascular invasion, which increased the 5-year survival rate of patients by 14%, reduced complications by 15%, and reduced medical costs by 73%, and pioneered an early liver cancer treatment decision-making system based on "microvascular invasion prediction", which directly benefited 14,000 patients in total.
In view of the large population of patients with advanced liver cancer in mainland China, in order to accurately select surgical treatment and effectively benefit the majority of patients, he explored and discovered imaging features that reflect the biological characteristics of multiple liver cancer (different tumor origins between individuals), so as to establish an individualized survival prediction of the surgical decision-making model of middle and advanced liver cancer, and accurately select surgical patients, so that the 5-year survival rate reached 46.5%, which is significantly better than the efficacy of traditional methods such as selecting patients according to tumor volume and number in the world. He extended this decision-making model of "finding characteristics, building models, and selecting patients" to patients with 7 different diseases such as giant tumors, and established new technologies such as double-vessel embolization and downstage resection, phased treatment of tumor rupture, and intraoperative bleeding control, forming a precise decision-making system for middle and advanced liver cancer surgery, which was applied to 27,000 patients. The results of the study rewrote the guidelines for the staging of TNM in liver cancer, and 7 results were included in the guidelines of the National Health Commission.
In the course of many years of clinical service, Shen Feng often encountered patients or their families asking him: "How much does the operation cost?" and "How much does the medicine cost?" In this scenario, Shen Feng always took the trouble to patiently explain over and over again, telling them why they need surgery and why they need drug treatment in easy-to-understand language, and helping them calculate the cost of surgery and follow-up treatment in detail, as well as estimating how to combine drugs to minimize the cost. Shen Feng said: "In addition to empathy, we also want to reduce the burden on patients when we study treatment decisions."
Provide a "Chinese solution" for the prevention and treatment of hepatobiliary tumor recurrence
The recurrence rate of hepatobiliary cancer is more than 70% after resection of liver cancer, and the recurrence rate of intrahepatic cholangiocarcinoma is more than 80% after resection.
In order to conquer this medical fortress, Shen Feng led his team members to once again attack the peak of the frontier of hepatobiliary medicine. In Shen Feng's view: "We are a very small team, including graduate students, there are only a dozen people, but everyone is very united and hardworking. Whether it's outpatient visits, surgeries, or medical research, our team members are all about benefiting patients. Because of this, all the research of the team is derived from clinical sources, and all the results must be used by patients. ”
"The importance of medical decision-making is not only reflected in the start of cancer treatment, but throughout the whole process of treatment, including the prevention of recurrence after surgery, the continuation of treatment after recurrence, etc., every key node is a new beginning, and decisions need to be made." Shen Feng admits that "only by applying individualized decision-making to the whole course of the disease can the survival rate of patients be maximized." ”
It has become an academic consensus that the prevention and treatment of hepatobiliary tumor recurrence must be individualized, but there is a lack of effective programs. According to the different mechanisms of early recurrence (related to tumor aggressiveness) and long-term recurrence (related to inflammation) after surgery, Shen Feng identified the pathological factors and biomarkers of high-risk recurrence according to the common recurrence patterns, and created 8 individualized risk prediction models, based on which the precise prevention of high-risk subjects of recurrence was realized. On this basis, he created 10 new anti-recurrence technologies, such as radioimmunotherapy targeting CD147 and radiotherapy targeting narrow margins, and formed precise anti-recurrence systemic strategies and technologies, which reduced the 5-year recurrence rate of liver cancer from 76.7% to 57.9%, and the 5-year recurrence rate of intrahepatic cholangiocarcinoma from 86.5% to 70.5%. He led the formulation of the first "Chinese Expert Consensus on the Prevention and Treatment of Liver Cancer Recurrence", and the research results were evaluated by The Lancet Gastroenterology as an important and unique research on targeted therapy, and was rated as one of the major achievements in the field of surgery in mainland China in the past 50 years since the founding of the People's Republic of China.
Shen Feng operated on the patient. Courtesy of the Third Affiliated Hospital of the Naval Medical University
"Whether it is a first-time occurrence or a recurrence of liver cancer, early detection and early diagnosis are still the key to improving efficacy and prolonging patient survival." Feng Shen led the team to create an ASAP model for hepatitis B-related liver cancer to individualize the risk of liver cancer in patients with chronic hepatitis B. This model is more accurate than the GALAD method recommended by international guidelines, and the cost of testing is reduced by half, and after the release of this result in 2019, it has been applied to more than 300,000 patients free of charge in dozens of tertiary hospitals in China.
Ten years of sharpening a sword. Shen Feng took the lead in undertaking the "Individualized Treatment of Liver Cancer" from the 11th Five-Year Plan to the 13th Five-Year Plan, a major national science and technology special project, and the research results were included in 42 international diagnosis and treatment guidelines; he won 1 second prize of the National Science and Technology Progress Award, 1 first prize of the Military Medical Achievement Award and 2 first prizes of the Shanghai Science and Technology Progress Award as the first person to complete the project; successively served as the director of the International Hepatobiliary and Pancreatic Association (7 in total), the vice chairman of the Asia-Pacific Liver Surgery Development Committee, the secretary-general of the Asia-Pacific Hepatobiliary and Pancreatic Association, He is the chairman of the Liver Cancer Special Committee of the Chinese Society of Clinical Oncology, and has been awarded the Military Science and Technology Leading Talent, Shanghai Leading Talent and Shanghai Top Ten Science and Technology Elite.
The header picture shows Professor Shen Feng introducing the new progress of liver cancer research at the academic conference. Photo courtesy of the Third Affiliated Hospital of the Naval Medical University (all photos in this article are Cao Xi)