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Recently, the famous Hong Kong movie star Wu Mengda and the well-known mainland musician Zhao Yingjun have passed away from liver cancer, and the world can't help but sigh.
Hepatocarcinoma is known as the "king of cancer", mainly because it is difficult to detect liver cancer in its early stages, and most patients are diagnosed as middle and late stage.
It took less than 3 months from Wu Mengda's discovery of liver cancer to his death.
He was already at an advanced stage when he was discovered.
And Zhao Yingjun, a well-known musician who died of liver cancer in February, was also at an advanced stage when he was diagnosed with liver cancer.
The liver is an important organ in the human body.
It plays an important role in the metabolism of fat, sugar and amino acids.
It performs as many as 500 different functions.
A normal and healthy liver has a strong ability to regenerate and repair itself, while chronic inflammation can permanently damage the liver, which can further develop into cirrhosis, liver cancer or liver failure over time.
The onset of primary liver cancer is hidden and has no specific clinical manifestations.
It is often found to have advanced to an advanced stage and miss the best opportunity for treatment, so the prognosis is poor.
Under normal circumstances, the natural survival period of patients with advanced liver cancer discovered in the clinic is usually only 3 to 6 months.
In order to standardize the effective prevention, early screening and diagnosis of people at risk of primary liver cancer, the Society of Hepatology of the Chinese Medical Association organized relevant domestic experts, based on the basic, clinical, and prevention research progress of primary liver cancer at home and abroad, combined with the current stage According to the actual situation in my country, the "Consensus on the Secondary Prevention of Primary Liver Cancer (2021 Edition)" was formulated to provide an important basis for the prevention, screening and early diagnosis of primary liver cancer in people with chronic liver diseases.
Primary liver cancer is currently one of the common malignant tumors in my country and the main cause of death, mainly including three different pathological types: hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and HCC-ICC mixed type.
Among them, HCC accounts for 85% to 90%.
For the prevention of liver cancer, this consensus adopts the following classification concepts: primary prevention is a measure to prevent the risk factors that can lead to HCC from initially harming the general population; secondary prevention is for people with chronic liver disease to control related causes and risk factors and According to risk stratification screening and monitoring, measures to reduce or delay the occurrence of HCC; tertiary prevention is to take further measures to reduce the recurrence of HCC, reduce the mortality rate and improve the overall survival rate after the radical treatment of patients who have developed HCC (Picture).
Figure HCC tertiary prevention target population and measures Epidemiology The World Health Organization International Agency for Cancer Research released the latest global cancer burden data in December 2020.
The incidence of primary liver cancer ranks sixth in malignant tumors, with 906,000 new cases; The mortality rate ranks third, with a total of 830,000 cases.
In the past five years, the global average annual incidence of primary liver cancer is 995,000 cases, 732,000 cases in Asia, accounting for 73.
6% of the world, and 423,000 cases in China, accounting for 42.
5% of the world.
Causes and risk factors of HCC Cirrhosis caused by various reasons is the main risk factor for the occurrence of HCC.
The main cause of HCC in my country is chronic hepatitis B virus (HBV) infection, accounting for about 86%; other causes include chronic hepatitis C virus (HCV) infection, alcoholic liver disease (ALD) caused by long-term excessive drinking, and non-alcoholic Fatty liver disease (NAFLD) and type 2 diabetes (T2DM), long-term consumption of aflatoxin-contaminated food, etc.
Recommendation 1: Liver cirrhosis caused by any etiology is at risk of HCC.
Hepatitis B cirrhosis is the main cause of HCC in my country and is the key monitoring population for screening (A1).
Recommendation 2: The superposition of multiple causes or risk factors (such as chronic HBV or HCV infection with ALD, NAFLD, T2DM or metabolic syndrome, etc.
) can significantly increase the risk of HCC.
Such people should closely monitor the occurrence of HCC (B1) .
Recommendation 3: Precancerous lesions confirmed by imaging (liver imaging report and data management system level 4) are extremely high-risk groups of HCC, and nodule growth and changes in nature should be closely monitored (B1).
The occurrence and development of HCC in people at risk of HCC is related to continuous liver inflammation, repair and fibrous tissue proliferation, and abnormal hepatocyte proliferation.
The current guidelines for the diagnosis and treatment of liver cancer in Europe and the United States differ in the definition of HCC high-risk groups.
This consensus combines the causes of HCC in my country, epidemiological characteristics, and evidence-based medical evidence, and stratifies the risk groups according to the risk level of HCC occurrence.
, And establish the corresponding monitoring program accordingly.
Low-risk population: age <30 years old, early and stable phase of chronic liver disease caused by various reasons, no obvious liver inflammation and fibrosis, including chronic inactive hepatitis B virus surface antigen (HBsAg) carriers, hepatitis B Patients with immune control stage, simple fatty liver, and benign genetic metabolic liver diseases such as Gilbert syndrome, Dubin-Johnson syndrome, benign recurrent intrahepatic cholestasis, etc.
Intermediate risk population: patients with chronic hepatitis B (CHB) aged> 30 years (no family history of liver cancer, no long-term alcoholism, smoking, clear history of exposure to carcinogenic toxins, no diabetes or obesity), chronic hepatitis C (CHC) Patients with active chronic liver disease such as ALD, non-alcoholic steatohepatitis (NASH), autoimmune liver disease or Wilson disease.
High-risk population: ① Liver cirrhosis caused by various reasons, including HBV infection, HCV infection, ALD, NAFLD, drug-induced liver injury, autoimmune liver disease, Wilson disease and other patients with active chronic liver disease.
Patients with liver cirrhosis caused by diseases and other diseases; ② CHB patients aged ≥ 30 years have a family history of liver cancer, or have long-term alcoholism, smoking, a clear history of exposure to carcinogenic toxins, diabetes or obesity.
High-risk groups: High-risk groups are accompanied by one or more of the following.
①Ultrasound and other imaging examinations found suspected precancerous lesions or atypical space-occupying lesions in the liver; ② Serum AFP≥20ng/ml, with or without DCP≥40mAU/ml and/or AFP-L3≥15%; ③Image Hepatic dysplasia nodules confirmed by hepatology or liver histopathology.
Secondary prevention measures for primary liver cancer The secondary prevention of HCC is aimed at early detection and early diagnosis, improving the radical cure rate and long-term survival rate.
Serum marker recommendation 4: AFP is still the first choice for screening early HCC (A1).
Combined detection with abnormal prothrombin (PIVKA-Ⅱ) and AFP-L3 can improve the diagnosis rate of early HCC (B2) .
Recommendation 5: For patients with negative or mildly elevated serum AFP, the combined detection of PIVKA-Ⅱ and AFP-L3 on the basis of dynamic observation can improve the early diagnosis rate of HCC (B2).
Imaging examination recommendation 6: Routine abdominal ultrasound is the main imaging method for HCC risk population monitoring, which can find tumors and nodules> 2 cm; CEUS can assist in identifying the nature of tumors (A1).
Recommendation 7: Liver CT plain scan and enhancement are one of the important imaging methods for early detection and early diagnosis of HCC, which can be used for the differential diagnosis and monitoring of nodules with a diameter of more than 1 cm (A1).
Recommendation 8: Multi-mode MRI (plain scan, DWI, and enhancement) is the most sensitive imaging method for diagnosing HCC.
It can find tumors with a diameter of ≤1cm.
It is used for HCC screening in nodular cirrhosis and identifying suspicious nodules found by ultrasound.
Section nature.
Gd-EOB-DTPA, a hepatocyte specific contrast agent, enhanced MRI can increase the detection rate of HCC with a diameter of ≤1cm, and has important clinical application value for distinguishing benign hyperplastic nodules, precancerous lesions and early HCC (A1).
Recommendation 9: Accurate evaluation of liver reserve function and liver stiffness has certain reference value for predicting the risk of HCC in chronic liver disease (C2).
Recommendation 10 for liver cancer screening and monitoring: Abdominal ultrasound combined with AFP is a routine screening method for HCC in patients with chronic liver disease, and multi-mode liver MRI and/or CT is an enhanced screening method.
Routine screening is carried out once a year for low-risk groups, and routine screening every 6 months (C1) for middle-risk groups; routine screening every 3-6 months (A1) for high-risk groups, every 6-12 months 1 Intensified screening (B2); routine screening once every 3 months for very high-risk groups, and once every 6 months (B1).
Recommendation 11: During the monitoring process, abdominal ultrasound finds nodules less than 1 cm, and re-examination is performed once every 3 months.
If nodules grow or nodules are greater than 1 cm and AFP is greater than 20 ng/ml, an enhanced screening process for liver cancer should be initiated.
If the nature of the nodule cannot be determined by imaging examination, a diagnostic liver biopsy under imaging guidance may be considered (C1).
Figure HCC Risk Population Hierarchical Screening Flowchart Recommendations for Treatment and Prevention of Liver Cancer Related Diseases 12: CHB patients should use nucleoside (acid) analogs (NAs) or peginterferon-α (PEG-IFNα) for antiviral Treatment.
CHC patients are treated with antiviral drugs and obtain sustained virological response, which can reduce the risk of HCC, but cannot completely eliminate it.
Especially for patients who have entered the stage of cirrhosis, the occurrence of HCC must be monitored according to the screening process after obtaining a virological response.
(A1).
Recommendation 13: Abstaining alcohol can reduce the risk of HCC in ALD patients (A1).
Recommendation 14: NAFLD patients should control their weight and prevent metabolic disorders by changing their unhealthy lifestyle, increasing aerobic exercise and other measures to reduce the risk of HCC (B1).
Recommendation 15: Chronic liver disease combined with T2DM increases the risk of HCC, and blood glucose levels should be strictly monitored and controlled (B1).
Reference: Consensus on Secondary Prevention of Primary Liver Cancer (2021 Edition).
Journal of Clinical Hepatobiliary Diseases, Volume 37, Issue 3.
Hepatocarcinoma is known as the "king of cancer", mainly because it is difficult to detect liver cancer in its early stages, and most patients are diagnosed as middle and late stage.
It took less than 3 months from Wu Mengda's discovery of liver cancer to his death.
He was already at an advanced stage when he was discovered.
And Zhao Yingjun, a well-known musician who died of liver cancer in February, was also at an advanced stage when he was diagnosed with liver cancer.
The liver is an important organ in the human body.
It plays an important role in the metabolism of fat, sugar and amino acids.
It performs as many as 500 different functions.
A normal and healthy liver has a strong ability to regenerate and repair itself, while chronic inflammation can permanently damage the liver, which can further develop into cirrhosis, liver cancer or liver failure over time.
The onset of primary liver cancer is hidden and has no specific clinical manifestations.
It is often found to have advanced to an advanced stage and miss the best opportunity for treatment, so the prognosis is poor.
Under normal circumstances, the natural survival period of patients with advanced liver cancer discovered in the clinic is usually only 3 to 6 months.
In order to standardize the effective prevention, early screening and diagnosis of people at risk of primary liver cancer, the Society of Hepatology of the Chinese Medical Association organized relevant domestic experts, based on the basic, clinical, and prevention research progress of primary liver cancer at home and abroad, combined with the current stage According to the actual situation in my country, the "Consensus on the Secondary Prevention of Primary Liver Cancer (2021 Edition)" was formulated to provide an important basis for the prevention, screening and early diagnosis of primary liver cancer in people with chronic liver diseases.
Primary liver cancer is currently one of the common malignant tumors in my country and the main cause of death, mainly including three different pathological types: hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and HCC-ICC mixed type.
Among them, HCC accounts for 85% to 90%.
For the prevention of liver cancer, this consensus adopts the following classification concepts: primary prevention is a measure to prevent the risk factors that can lead to HCC from initially harming the general population; secondary prevention is for people with chronic liver disease to control related causes and risk factors and According to risk stratification screening and monitoring, measures to reduce or delay the occurrence of HCC; tertiary prevention is to take further measures to reduce the recurrence of HCC, reduce the mortality rate and improve the overall survival rate after the radical treatment of patients who have developed HCC (Picture).
Figure HCC tertiary prevention target population and measures Epidemiology The World Health Organization International Agency for Cancer Research released the latest global cancer burden data in December 2020.
The incidence of primary liver cancer ranks sixth in malignant tumors, with 906,000 new cases; The mortality rate ranks third, with a total of 830,000 cases.
In the past five years, the global average annual incidence of primary liver cancer is 995,000 cases, 732,000 cases in Asia, accounting for 73.
6% of the world, and 423,000 cases in China, accounting for 42.
5% of the world.
Causes and risk factors of HCC Cirrhosis caused by various reasons is the main risk factor for the occurrence of HCC.
The main cause of HCC in my country is chronic hepatitis B virus (HBV) infection, accounting for about 86%; other causes include chronic hepatitis C virus (HCV) infection, alcoholic liver disease (ALD) caused by long-term excessive drinking, and non-alcoholic Fatty liver disease (NAFLD) and type 2 diabetes (T2DM), long-term consumption of aflatoxin-contaminated food, etc.
Recommendation 1: Liver cirrhosis caused by any etiology is at risk of HCC.
Hepatitis B cirrhosis is the main cause of HCC in my country and is the key monitoring population for screening (A1).
Recommendation 2: The superposition of multiple causes or risk factors (such as chronic HBV or HCV infection with ALD, NAFLD, T2DM or metabolic syndrome, etc.
) can significantly increase the risk of HCC.
Such people should closely monitor the occurrence of HCC (B1) .
Recommendation 3: Precancerous lesions confirmed by imaging (liver imaging report and data management system level 4) are extremely high-risk groups of HCC, and nodule growth and changes in nature should be closely monitored (B1).
The occurrence and development of HCC in people at risk of HCC is related to continuous liver inflammation, repair and fibrous tissue proliferation, and abnormal hepatocyte proliferation.
The current guidelines for the diagnosis and treatment of liver cancer in Europe and the United States differ in the definition of HCC high-risk groups.
This consensus combines the causes of HCC in my country, epidemiological characteristics, and evidence-based medical evidence, and stratifies the risk groups according to the risk level of HCC occurrence.
, And establish the corresponding monitoring program accordingly.
Low-risk population: age <30 years old, early and stable phase of chronic liver disease caused by various reasons, no obvious liver inflammation and fibrosis, including chronic inactive hepatitis B virus surface antigen (HBsAg) carriers, hepatitis B Patients with immune control stage, simple fatty liver, and benign genetic metabolic liver diseases such as Gilbert syndrome, Dubin-Johnson syndrome, benign recurrent intrahepatic cholestasis, etc.
Intermediate risk population: patients with chronic hepatitis B (CHB) aged> 30 years (no family history of liver cancer, no long-term alcoholism, smoking, clear history of exposure to carcinogenic toxins, no diabetes or obesity), chronic hepatitis C (CHC) Patients with active chronic liver disease such as ALD, non-alcoholic steatohepatitis (NASH), autoimmune liver disease or Wilson disease.
High-risk population: ① Liver cirrhosis caused by various reasons, including HBV infection, HCV infection, ALD, NAFLD, drug-induced liver injury, autoimmune liver disease, Wilson disease and other patients with active chronic liver disease.
Patients with liver cirrhosis caused by diseases and other diseases; ② CHB patients aged ≥ 30 years have a family history of liver cancer, or have long-term alcoholism, smoking, a clear history of exposure to carcinogenic toxins, diabetes or obesity.
High-risk groups: High-risk groups are accompanied by one or more of the following.
①Ultrasound and other imaging examinations found suspected precancerous lesions or atypical space-occupying lesions in the liver; ② Serum AFP≥20ng/ml, with or without DCP≥40mAU/ml and/or AFP-L3≥15%; ③Image Hepatic dysplasia nodules confirmed by hepatology or liver histopathology.
Secondary prevention measures for primary liver cancer The secondary prevention of HCC is aimed at early detection and early diagnosis, improving the radical cure rate and long-term survival rate.
Serum marker recommendation 4: AFP is still the first choice for screening early HCC (A1).
Combined detection with abnormal prothrombin (PIVKA-Ⅱ) and AFP-L3 can improve the diagnosis rate of early HCC (B2) .
Recommendation 5: For patients with negative or mildly elevated serum AFP, the combined detection of PIVKA-Ⅱ and AFP-L3 on the basis of dynamic observation can improve the early diagnosis rate of HCC (B2).
Imaging examination recommendation 6: Routine abdominal ultrasound is the main imaging method for HCC risk population monitoring, which can find tumors and nodules> 2 cm; CEUS can assist in identifying the nature of tumors (A1).
Recommendation 7: Liver CT plain scan and enhancement are one of the important imaging methods for early detection and early diagnosis of HCC, which can be used for the differential diagnosis and monitoring of nodules with a diameter of more than 1 cm (A1).
Recommendation 8: Multi-mode MRI (plain scan, DWI, and enhancement) is the most sensitive imaging method for diagnosing HCC.
It can find tumors with a diameter of ≤1cm.
It is used for HCC screening in nodular cirrhosis and identifying suspicious nodules found by ultrasound.
Section nature.
Gd-EOB-DTPA, a hepatocyte specific contrast agent, enhanced MRI can increase the detection rate of HCC with a diameter of ≤1cm, and has important clinical application value for distinguishing benign hyperplastic nodules, precancerous lesions and early HCC (A1).
Recommendation 9: Accurate evaluation of liver reserve function and liver stiffness has certain reference value for predicting the risk of HCC in chronic liver disease (C2).
Recommendation 10 for liver cancer screening and monitoring: Abdominal ultrasound combined with AFP is a routine screening method for HCC in patients with chronic liver disease, and multi-mode liver MRI and/or CT is an enhanced screening method.
Routine screening is carried out once a year for low-risk groups, and routine screening every 6 months (C1) for middle-risk groups; routine screening every 3-6 months (A1) for high-risk groups, every 6-12 months 1 Intensified screening (B2); routine screening once every 3 months for very high-risk groups, and once every 6 months (B1).
Recommendation 11: During the monitoring process, abdominal ultrasound finds nodules less than 1 cm, and re-examination is performed once every 3 months.
If nodules grow or nodules are greater than 1 cm and AFP is greater than 20 ng/ml, an enhanced screening process for liver cancer should be initiated.
If the nature of the nodule cannot be determined by imaging examination, a diagnostic liver biopsy under imaging guidance may be considered (C1).
Figure HCC Risk Population Hierarchical Screening Flowchart Recommendations for Treatment and Prevention of Liver Cancer Related Diseases 12: CHB patients should use nucleoside (acid) analogs (NAs) or peginterferon-α (PEG-IFNα) for antiviral Treatment.
CHC patients are treated with antiviral drugs and obtain sustained virological response, which can reduce the risk of HCC, but cannot completely eliminate it.
Especially for patients who have entered the stage of cirrhosis, the occurrence of HCC must be monitored according to the screening process after obtaining a virological response.
(A1).
Recommendation 13: Abstaining alcohol can reduce the risk of HCC in ALD patients (A1).
Recommendation 14: NAFLD patients should control their weight and prevent metabolic disorders by changing their unhealthy lifestyle, increasing aerobic exercise and other measures to reduce the risk of HCC (B1).
Recommendation 15: Chronic liver disease combined with T2DM increases the risk of HCC, and blood glucose levels should be strictly monitored and controlled (B1).
Reference: Consensus on Secondary Prevention of Primary Liver Cancer (2021 Edition).
Journal of Clinical Hepatobiliary Diseases, Volume 37, Issue 3.
