Golubnitschaja Olga, Polivka Jiri, Yeghiazaryan Kristina, Berliner Leonard
1Department of Radiology, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany.
2Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
EPMA J. 2018 Aug 17;9(3):271-285. doi: 10.1007/s13167-018-0146-6. eCollection 2018 Sep.
The annually recorded incidence of primary hepatic carcinomas has significantly increased over the past two decades accounting for over 800 thousand of annual deaths caused by hepatocellular carcinoma (HCC) alone globally. Further, secondary liver malignancies are much more widespread compared to primary hepatic carcinomas: almost all solid malignancies are able to metastasise into the liver. The primary tumours most frequently metastasising to the liver are breast followed by colorectal carcinomas. Given the increased incidence of both primary and metastatic liver cancers, a new, revised approach is needed to advance medical care based on predictive diagnostics, innovative screening programmes, targeted preventive measures, and patient stratification for treatment algorithms tailored to individualised patient profile.
The current pilot study took advantage of systemic alterations characteristic for liver malignancies, utilising liquid biopsy (blood samples) and specific biomarker patterns detected. Key molecular pathways relevant for pathomechanisms of liver cancers have been considered opening a perspective for both-individualised diagnostics and targeted treatment. Systemic alterations have been analysed prior to the therapy application avoiding molecular biological effects potentially diminishing predictive power of the biomarker-panel proposed. Multi-omics at DNA and protein (both expression and activity) levels has been applied. An established biomarker panel is considered as a powerful tool for individualised patient profiling and improved multi-level diagnostics-both predictive and prognostic ones.
Biomarker panels have been created for the patient stratification, prediction of a more optimal therapy and prognosis of survival based on the individualised patient profiling. Although there are some limitations of the pilot study performed, the results are encouraging, as it may be possible, through further research along these lines, to find a clinically and cost-effective means of stratifying liver cancer patients for personalised care and therapy. The benefits to the patient and society of accurate treatment stratification cannot be overemphasised.
在过去二十年中，每年记录的原发性肝癌发病率显著上升，仅全球范围内肝细胞癌（HCC）每年就导致超过80万人死亡。此外，继发性肝恶性肿瘤比原发性肝癌更为普遍：几乎所有实体恶性肿瘤都能够转移至肝脏。最常转移至肝脏的原发性肿瘤是乳腺癌，其次是结直肠癌。鉴于原发性和转移性肝癌的发病率均有所上升，需要一种新的、经过修订的方法，以基于预测性诊断、创新筛查计划、针对性预防措施以及根据个体化患者特征制定的治疗算法进行患者分层，从而推进医疗护理。
当前的试点研究利用了肝脏恶性肿瘤的系统性改变，采用了液体活检（血液样本）并检测了特定的生物标志物模式。考虑了与肝癌发病机制相关的关键分子途径，为个体化诊断和靶向治疗开辟了前景。在应用治疗之前对系统性改变进行了分析，避免了可能削弱所提出的生物标志物面板预测能力的分子生物学效应。在DNA和蛋白质（表达和活性）水平上应用了多组学技术。一个既定的生物标志物面板被认为是用于个体化患者特征分析以及改进多层次诊断（预测性和预后性诊断）的有力工具。
已经创建了生物标志物面板，用于基于个体化患者特征进行患者分层、预测更优治疗以及生存预后。尽管所进行的试点研究存在一些局限性，但结果令人鼓舞，因为沿着这些思路进一步研究有可能找到一种临床和成本效益高的方法，对肝癌患者进行分层以实现个性化护理和治疗。准确的治疗分层对患者和社会的益处怎么强调都不为过。
