Bring more benefits to liver cancer patients!

According to data from the International Agency for Research on Cancer (IARC), there will be 910,000 new cases of liver cancer worldwide in 2020, ranking sixth among the top ten most common cancers, but the number of deaths is third with 830,000
.
In China, there will be 410,000 new cases of liver cancer in 2020, accounting for 45% of the global total, and 390,000 deaths, accounting for 47% of the global total
.
China is a veritable country with liver cancer, and the social burden is heavy
.
In order to understand the overall level of prevention and treatment of liver cancer in China and strengthen the public's awareness of this malignant tumor, Sina Pharmaceutical interviewed Professor Xing Baocai, director of the First Department of Hepatobiliary and Pancreatic Surgery, Peking University Cancer Hospital, during the National Cancer Prevention and Control Publicity Week in 2022.
The incidence of liver cancer, early screening, early prevention, early diagnosis and the importance of early treatment were introduced in detail
.
Insidious onset, rapid progress! Take multiple measures to prevent liver cancer Liver cancer is a malignant tumor that occurs in the liver, including primary liver cancer and secondary liver cancer
.
Primary liver cancer refers to cancers caused by lesions of the liver itself, including hepatocellular carcinoma, cholangiocarcinoma and mixed liver cancer
.
Among them, hepatocellular carcinoma accounts for more than 80% of primary liver cancers
.
Secondary liver cancer is caused by the metastasis of cancer in other organs of the body to the liver, such as gastric cancer, colon cancer, breast cancer, pancreatic cancer metastasis,
etc.
Regarding the causes of liver cancer, Professor Xing Baocai introduced that more than 80% of liver cancers in China develop from hepatitis B and C, and most of the patients follow the development law of hepatitis-cirrhosis-hepatocellular carcinoma
.
However, in the 1990s, my country began to inject hepatitis B vaccine into newborns, and since 2002, the government has included hepatitis B vaccine in the planned immunization; therefore, the hepatitis B infection rate among the younger generation has dropped significantly, and liver cancer caused by hepatitis will also follow.
reduce
.
However, other pathogenic factors cannot be ignored, such as: (1) alcoholic liver cirrhosis caused by long-term heavy drinking may develop into liver cancer; (2) aflatoxin produced by mildew in food, smoked and preserved foods Contained nitrosamines and polluted water sources are also related to the occurrence of liver cancer; (3) Fatty liver caused by obesity, if not controlled and treated in time, may also cause liver cancer
.
How to prevent liver cancer? Professor Xing Baocai reminded that there are generally no obvious clinical symptoms in the early stage of liver cancer, and some patients may have poor appetite, fatigue, and weight loss, but the symptoms are not specific and are easily overlooked; Pain will be felt, but most of them have reached the middle and late stage at this time, the treatment is difficult, the treatment effect is poor, and the 5-year survival rate is less than 20%
.
Therefore, for the prevention of liver cancer, first of all, it is necessary to eliminate its main pathogenic factor-hepatitis, and it is necessary to vaccinate against hepatitis B throughout the course
.
For high-risk groups with a family history of hepatitis B, hepatitis C, cirrhosis, fatty liver, and liver cancer, imaging examinations and AFP (alpha-fetoprotein) screening should be done every 6 months.
Once liver cirrhosis evolves into liver cancer, it can be detected early
.
In addition, in daily life, we should pay attention to diet, drinking water hygiene, drink less alcohol, and eat less smoked and preserved foods
.
Early stage patients: resection is still the preferred treatment method For the treatment of liver cancer, Professor Xing Baocai once put forward the concept of "organically combining oncology and surgery, and striving to maximize the benefit of patients"
.
Indeed, multidisciplinary participation and coexistence of multiple treatment methods are the best treatment modes for liver cancer treatment
.
Common treatment methods for liver cancer include liver resection, liver transplantation, ablation therapy, TACE (hepatic arterial chemoembolization), radiation therapy, and systemic antitumor therapy
.
Clinically, it is necessary to choose a reasonable and individualized treatment plan for patients with different stages of liver cancer to maximize the survival benefit of liver cancer patients
.
For patients with early-stage liver cancer, radical means such as surgical resection, ablation or liver transplantation are still the first choice, and patients can achieve long-term survival and even cure.

.
However, due to the very strict screening criteria for liver transplantation, coupled with the shortage of liver sources and the high cost, only a small number of patients can receive liver transplantation
.
Therefore, liver resection remains the primary treatment for early stage patients
.
Since the world's first successful liver resection was performed in 1888, the medical community's understanding of liver anatomy has continued to deepen
.
At the same time, with the improvement of blood flow control technology and the successive invention of new liver cutting devices, liver resection has become more and more mature
.
However, it is undeniable that due to individual differences in patients and problems of surgical operation, the mortality rate of liver resection patients is still about 1%, and the incidence of postoperative complications can be as high as 30-40%
.
Therefore, it is necessary to attach great importance to the perioperative management of liver resection to reduce intraoperative mortality and postoperative complications
.
In this regard, Professor Xing Baocai believes that it should be carried out in accordance with the standard of "accurate evaluation of tumors before surgery; superb surgery for patients during surgery; careful observation and treatment of patients after surgery"
.
Specifically, before surgery, the size and location of the lesion should be determined by imaging methods, and the tumor should be accurately staged.
At the same time, the patient's physical fitness, nutritional status, psychological status, basic liver disease status, liver reserve function, remaining liver volume, etc.
should be accurately assessed.
, and the risk of postoperative recurrence, to determine whether the patient can undergo surgery
.
In addition, conversion therapy should be performed for unresectable liver cancer before surgery, so that some patients can obtain the opportunity of surgical resection, and anti-viral liver-protective therapy should be performed for hepatitis B patients to improve the safety of surgery
.
Regarding the precautions in the process of liver resection, Professor Xing Baocai believes that firstly, the tumor should be completely removed to ensure that there is no residual margin; secondly, sufficient volume and functional liver tissue should be preserved as much as possible; at the same time, efforts should be made to reduce intraoperative Bleeding, shorten operation time, reduce operative mortality, and reduce postoperative complications
.
During the operation, laparoscopic surgery, robotic surgery or open surgery can be selected according to the specific conditions of the patient
.
After surgery, early monitoring is required, and complications such as excessive liver function indicators, coagulation dysfunction, and ascites should be dealt with in a timely manner.

.
In addition, pain management should be done well, the drainage tube should be pulled out reasonably early, psychological counseling and counseling should be done for patients, and postoperative nutritional support should be strengthened, so that patients can survive the operation smoothly and recover quickly
.
Intermediate-advanced patients: Targeted + immune combination therapy can be expected in the future.
Although surgical resection is still an important means to cure liver cancer and achieve long-term survival, about 80% of patients in China are in the late stage of unresectable or metastatic disease at the first diagnosis, and they have lost surgery.
opportunity
.
In this regard, other related treatment methods, such as chemotherapy, interventional therapy, ablation therapy, targeted therapy, immunotherapy, etc.
, can be used to strive for the opportunity of radical surgery for advanced patients, which is of great significance for improving their prognosis
.
In particular, the rapid development of targeted therapy and immunotherapy has significantly improved the therapeutic effect of liver cancer, prolonged the survival period of patients with advanced stage, and realized the transformation of unresectable liver cancer, bringing more benefits to patients with advanced liver cancer.

.
Regarding targeted therapy, the approval of sorafenib in 2007 was a milestone in the field of liver cancer
.
Sorafenib is a multi-target, multi-kinase inhibitor that inhibits tumor cell proliferation and angiogenesis by targeting serine/threonine kinases and receptor tyrosine kinases on tumor cells and tumor blood vessels
.
Data show that sorafenib can maintain stable disease in more than 40% of patients and prolong survival
.
The ORIENTAL and SHARP trials of the drug in the east and west have been successful, and the OS of patients with advanced liver cancer has been greatly prolonged, which has established sorafenib as the first-line treatment for advanced liver cancer for more than ten years
.
The launch of sorafenib has officially opened the era of systemic treatment of liver cancer in China
.
However, for patients who have progressed on sorafenib treatment, there has been no better clinical response in the past
.
It was not until 2017 that regorafenib, the first second-line standard treatment drug for liver cancer, was approved, which provided new options and new hope for these patients.

.
Regorafenib is a novel oral multi-kinase inhibitor that exerts multiple anti-tumor effects of anti-angiogenesis, anti-tumor proliferation, anti-tumor metastasis and anti-immunosuppression by inhibiting a variety of protein kinases that promote tumor growth
.
Exploratory analysis of the RESORCE study showed that the median overall survival of patients treated with sorafenib followed by regorafenib compared with the placebo group after sorafenib treatment (median overall survival 19.
2 months) The survival time was extended to 26.
0 months, which means that sorafenib followed by regorafenib can bring longer survival benefit to patients with liver cancer
.
In addition, some studies have found that regorafenib, as a standard second-line targeted therapy drug, its unique multi-target and comprehensive anti-tumor effect can effectively solve the drug resistance dilemma of first-line therapy, and it can be used in combination with local therapy and combined immune therapy.
A good synergistic effect can be achieved in terms of treatment
.
Based on this, sorafenib and regorafenib are recommended as first- and second-line treatments in the latest "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)" issued by the National Health Commission
.
Now both regorafenib and sorafenib have entered the national medical insurance and the price has been greatly reduced, which has greatly reduced the treatment burden of Chinese liver cancer patients
.
On the other hand, immunotherapy has also developed rapidly in recent years
.
After 2017, new immunotherapy represented by immune checkpoint inhibitors has become another major breakthrough in the field of advanced liver cancer, and the treatment methods for liver cancer have become more and more abundant
.
However, any single treatment method has limitations.
In order to further improve the treatment effect of liver cancer, the medical community has begun to explore combination therapy - targeted therapy + immunotherapy
.
The rapid development of target-immune combination has brought great changes to the systemic treatment of unresectable liver cancer.
The ORR of patients has increased from 3-4% of the previous ORR of sorafenib to 30-40%
.
Professor Xing Baocai said, "After targeted immunotherapy, 1/3 of the people's tumors have shrunk significantly, and about 30% of them were originally unresectable.
After this treatment, they can be transformed into resectable
.
" I have to say that targeted therapy The powerful combination with immunotherapy has brought liver cancer treatment to a new level
.
At the same time, liver cancer surgery and various local treatment techniques are also constantly developing.
Combined with systemic therapy, a complete, three-dimensional, and whole-course comprehensive treatment model for liver cancer has been formed.
The survival time of patients has been prolonged and the quality of life has been significantly improved
.