Liver cancer , because of its high incidence and high mortality, has become a major killer that threatens health. Due to its atypical early symptoms, liver cancer is often ignored due to the "reticence" at the beginning, and is not discovered until the middle and late stages. Recently, at the press conference of "Getting closer to the consensus on irAE management of liver cancer", Academician of the Chinese Academy of Sciences , Dean of Zhongshan Hospital Affiliated to Fudan University Fan Jia, Vice President of Zhongshan Hospital Affiliated to Fudan University and Director of Liver Oncology Surgery Professor Zhou Jian and Professor Chen Min, Director of the Editorial Department of "Chinese Journal of Digestive Surgery" and other experts said in interviews with reporters that innovative therapies represented by immunotherapy have become one of the most important exploration directions in the treatment of liver cancer, but In addition to seeing the survival benefits and efficacy breakthroughs it may bring to patients, how to timely detect, early handle, and standardize the management of related adverse reactions has also become an issue that cannot be ignored in clinical medication. In the opinion of experts, this issue is related to the quality of life of patients. "Not only must they live longer, but they must also live well."
Why is liver cancer so “difficult” for the Chinese?
The National Cancer Center’s 2019 report shows that liver cancer is the fourth most common type of cancer and the second largest cause of cancer death in my country. In 2016 alone, there were as many as 389,000 new cases and deaths. 336,000 cases. The 2020 Global Cancer Report also shows that China’s liver cancer accounts for nearly half of the global data, both in terms of new cases and deaths.
Liver cancer “prefers” Chinese people? Professor Zhou Jian said frankly that unlike non-alcoholic steatohepatitis -related liver cancer in the United States and hepatitis C-related liver cancer in Japan, the proportion of hepatitis B-related liver cancer in China is more obvious. The "2019 China Hepatitis B Prevention and Treatment Guidelines" shows that among patients with cirrhosis and liver cancer in my country, 77% and 84% are caused by hepatitis B virus infection, respectively.
"Our strategies for preventing and treating liver cancer are significantly different from foreign strategies." Professor Zhou Jian pointed out that with the vaccination of hepatitis B vaccine , the incidence of hepatitis B in my country has been effectively curbed, and the average age of onset of liver cancer has also been postponed. "At present, we A lot of results have been achieved in the prevention and treatment of liver cancer, which is also the result of our Chinese characteristics . According to epidemiology and statistical expert predictions, the incidence of liver cancer in our country may decline significantly after 2050, but we will continue to practice it now It is still very necessary to adhere to the prevention and treatment strategy of liver cancer
From "incurable disease" to "partially treatable"
Starting from the promulgation and implementation of the " "Healthy China 2030" planning outline ", it is necessary to reduce the mortality rate of major chronic diseases such as cancer. It has become an important indicator of chronic prevention and control in my country. Liver cancer, as the fourth most common malignant tumor in my country and the second most deadly cancer, has always been a top priority in cancer prevention and control. In order to achieve the goals of the “Healthy China 2030” plan, China has Experts have done a lot of work in the field of liver cancer prevention, diagnosis, and treatment, and have achieved remarkable results. Academician Fan Jia said that based on the experience of early detection, early diagnosis, and early treatment of the older generation of experts, the current clinical practice is constantly promoting. Comprehensive and standardized diagnosis and treatment of liver cancer promotes the rational application of various new methods and means in clinical practice.
In terms of early screening and diagnosis of liver cancer, Academician Fan Jia pointed out that alpha-fetoprotein is an early stage liver cancer that has been used clinically for a long time. Indicators for diagnosis and dynamic monitoring of efficacy, but there are false negatives and false positives phenomena. Therefore, in recent years, the field of liver cancer has promoted abnormal prothrombin , microRNA (miRNA), and second-generation DNA sequencing technology (NGS). , 5-hydroxycytosine and other research and practice. Some research results have been applied in clinical applications, which have greatly improved the specificity and sensitivity of early diagnosis and screening of liver cancer. At the same time, more emerging early screening and early diagnosis methods are being further explored. And trying to translate it into clinical practice is expected to further improve the early screening and diagnosis rate of liver cancer.
In terms of treatment, my country has updated three editions of primary liver cancer diagnosis and treatment specifications and guidelines since 2017, and proposed treatment staging suitable for Chinese liver cancer patients ( CNLC), while continuously improving surgical techniques, great progress has also been made in drug innovation, interventional therapy , radiotherapy , etc., and the survival of liver cancer patients has been greatly improved.At present, many innovative treatment methods, such as systemic therapy combined with local therapy, have broadened the indications for liver cancer surgery. Through conversion therapy, tumors can be downstaged and shrunk to achieve conversion resection, allowing only 20%-30% of liver cancer patients to be operated on. More than 40%. With the in-depth development and clinical exploration of innovative drugs such as immune checkpoint inhibitors, comprehensive treatment of liver cancer has entered a new era. Some patients whose original drug treatment effects are not obvious can also achieve long-term survival through combined treatment. Chance.
Standardize the clinical practice of liver cancer by oncologists
Currently, the clinical application and research exploration of immune checkpoint inhibitors have further broadened the door to precision treatment of liver cancer. More and more new treatments are expected to bring hope for long-term survival to patients with liver cancer. At the same time, the Liver Cancer Group of the Oncology Branch of the Chinese Medical Association, led by Academician Fan Jia, formulated the "Chinese Expert Consensus on the Management of Adverse Reactions Related to Immune Checkpoint Inhibitors in Liver Cancer (2021 Edition)", which combines the characteristics of liver cancer in China with evidence-based medicine. Based on the evidence, we will guide clinicians to standardize the application of immune drugs, and strive to allow liver cancer patients to benefit from innovative treatments in a safer and more effective way.
In the past ten years, a series of normative documents on liver cancer prevention and treatment, such as the "Standards for the Diagnosis and Treatment of Primary Liver Cancer" and the "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer", have been released one after another, basically meeting the needs of guiding oncologists in the clinical practice of liver cancer treatment. "Immunotherapy has become a new treatment model for liver cancer, which brings huge benefits to patients. At the same time, the management of immune-related adverse reactions is an issue that cannot be ignored in clinical medication." Academician Fan Jia pointed out that through the formulation of expert consensus, the management of adverse reactions to various organs in patients with liver cancer Clinical issues such as reaction management, management of immune-related adverse reactions during combination therapy, and the use of immunotherapy in special populations will be discussed to allow clinicians to better standardize the management of immune-related adverse reactions, better ensure efficacy and improve patients' quality of life.
During the writing process of this consensus, not only experts in the field of liver cancer were invited, but also experts from multiple sub-disciplines were invited to focus on the characteristics of liver cancer patients, discuss hot and difficult issues in the management of adverse reactions to liver cancer, and put forward corresponding management opinions. and suggestions; at the same time, through publicity activities, we share experiences, learn from each other, and improve our ability to standardize the use of immunological drugs, so as to better benefit Chinese liver cancer patients. Professor Chen Min said, "Promoting the coverage of consensus, allowing high-quality academic resources to sink, allowing front-line clinicians to understand and recognize them, and apply them in practice to benefit patients is our original intention and ultimate goal."
"Today, Even for patients with advanced liver cancer, we have methods, means, and drugs. Various combined methods can achieve better results and reduce side effects during treatment, so that patients can survive long-term and maintain quality of life. " Academician Fan Jia also said that there is an important prerequisite for all this, which is that clinicians, scientific and technological workers and everyone should work hand in hand on the road to conquer liver cancer and contribute wisdom to the " Healthy China 2030" goal of increasing the survival rate by 15%. .
Author: Tang Wenjia
Editor: Tang Wenjia
