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肝细胞癌(HCC):流行病学、病因学和分子分类。

Hepatocellular carcinoma (HCC): Epidemiology, etiology and molecular classification.

机构信息

C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, United States.

Department of Human and Molecular Genetics, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States.

出版信息

Adv Cancer Res. 2021;149:1-61. doi: 10.1016/bs.acr.2020.10.001. Epub 2020 Nov 28.

Abstract

Hepatocellular carcinoma (HCC), the primary malignancy of hepatocytes, is a diagnosis with bleak outcome. According to National Cancer Institute's SEER database, the average five-year survival rate of HCC patients in the US is 19.6% but can be as low as 2.5% for advanced, metastatic disease. When diagnosed at early stages, it is treatable with locoregional treatments including surgical resection, Radio-Frequency Ablation, Trans-Arterial Chemoembolization or liver transplantation. However, HCC is usually diagnosed at advanced stages when the tumor is unresectable, making these treatments ineffective. In such instances, systemic therapy with tyrosine kinase inhibitors (TKIs) becomes the only viable option, even though it benefits only 30% of patients, provides only a modest (~3months) increase in overall survival and causes drug resistance within 6months. HCC, like many other cancers, is highly heterogeneous making a one-size fits all option problematic. The selection of liver transplantation, locoregional treatment, TKIs or immune checkpoint inhibitors as a treatment strategy depends on the disease stage and underlying condition(s). Additionally, patients with similar disease phenotype can have different molecular etiology making treatment responses different. Stratification of patients at the molecular level would facilitate development of the most effective treatment option. With the increase in efficiency and affordability of "omics"-level analysis, considerable effort has been expended in classifying HCC at the molecular, metabolic and immunologic levels. This review examines the results of these efforts and the ways they can be leveraged to develop targeted treatment options for HCC.

摘要

肝细胞癌 (HCC) 是肝细胞的原发性恶性肿瘤,其预后通常较差。根据美国国家癌症研究所的 SEER 数据库,美国 HCC 患者的平均五年生存率为 19.6%,但晚期转移性疾病的五年生存率可低至 2.5%。在早期诊断时,可通过局部区域治疗(包括手术切除、射频消融、经动脉化疗栓塞或肝移植)进行治疗。然而,当肿瘤无法切除时,HCC 通常在晚期被诊断,使这些治疗方法无效。在这种情况下,使用酪氨酸激酶抑制剂 (TKI) 的全身治疗成为唯一可行的选择,尽管它仅使 30%的患者受益,仅适度(~3 个月)延长总体生存时间,并在 6 个月内产生耐药性。HCC 与许多其他癌症一样,具有高度异质性,因此一种方法无法适用于所有情况。肝移植、局部区域治疗、TKI 或免疫检查点抑制剂作为治疗策略的选择取决于疾病阶段和潜在情况。此外,具有相似疾病表型的患者可能具有不同的分子病因,导致治疗反应不同。在分子水平上对患者进行分层将有助于制定最有效的治疗方案。随着“组学”水平分析效率和可负担性的提高,人们在分子、代谢和免疫水平上对 HCC 进行分类方面付出了相当大的努力。这篇综述考察了这些努力的结果以及利用这些结果开发 HCC 靶向治疗方案的方法。

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