Kysela P, Kala Z, Zatloukal M, Raudenská M, Brančíková D
Klin Onkol. 2022 Spring;35(2):100-113. doi: 10.48095/ccko2022100.
Though the sixth most frequent malignancy, hepatocellular carcinoma (HCC) is the third most common cause of death amongst solid tumours. Only surgery in the early stages may provide the cure; however, HCC still has a high recurrence rate. Non-surgical treatment lacks comparable efficacy. It was not sooner than in 2017 that the therapy galore started to extend. Thus prognostic factors driving the therapy have been gaining importance.
All relevant literature was checked for aetiology, epidemiology, dia-gnostic means, and individualised treatment of HCC. Cytochrome P-450 expression data from 22 patients operated in the University Hospital Brno in the period 2017-2020 were included.
Screening the population at risk (presence of cirrhosis) with the transabdominal ultrasound lies at the centre of the dia-gnostic algorithm. Making the dia-gnosis does not require a bio-psy in most cases. Only a few parameters are thus known before the treatment - a size and number of lesions, and AFP level. These drive the indication to surgery. Relapses after surgery and response to palliative treatment depend on the expression of MET and AXL that directly affect anti-VEGF therapy. High AFP predicts a good response to regorafenib but early relapse after surgery. The pattern of P450 expression was found linked with tumour differentiation. The differentiation correlates with the size and number of lesions. We also found a link between the P450 expression and some mi-RNAs possibly detectable using liquid bio-psy techniques.
The share of deaths from HCC overweighs its incidence. The risk population to screen is well-defined (cirrhosis). The BCLC staging system probably gives the best complication/efficacy results. This system does not require any bio-psy and does not comprise all predictive factors important in the expanding targeted molecular therapy. According to our results, small molecules to treat HCC should work better in poorly differentiated tumours. Surgery is more effective in those well-differentiated. It isnt easy to get all relevant information before therapy. Some factors need macrobio-psy (surgical). The pretreatment workup will probably require a mandatory bio-psy in BCLC B and C stages to get the information. This opens up a way for the liquid bio-psy that could use some specific mi RNAs.
肝细胞癌（HCC）虽是第六大常见恶性肿瘤，但却是实体瘤中第三大常见死因。只有早期手术有可能治愈；然而，HCC的复发率仍然很高。非手术治疗缺乏可比的疗效。直到2017年，大量的治疗方法才开始扩展。因此，驱动治疗的预后因素变得越来越重要。
检索所有相关文献，了解HCC的病因、流行病学诊断方法和个体化治疗。纳入了2017年至2020年期间在布尔诺大学医院接受手术的22例患者的细胞色素P-４５０表达数据。
经腹超声筛查高危人群（肝硬化患者）是诊断算法的核心。在大多数情况下，做出诊断不需要活检。因此，在治疗前仅知道少数参数——病变的大小和数量以及甲胎蛋白水平。这些参数决定了手术指征。手术后的复发和对姑息治疗的反应取决于MET和AXL的表达，它们直接影响抗血管内皮生长因子（VEGF）治疗。高甲胎蛋白水平预示着对瑞戈非尼有良好反应，但手术后早期复发。发现P450表达模式与肿瘤分化有关。分化与病变的大小和数量相关。我们还发现P450表达与一些可能可通过液体活检技术检测到的微小RNA之间存在联系。
HCC的死亡比例超过其发病率。需要筛查的高危人群定义明确（肝硬化）。巴塞罗那临床肝癌（BCLC）分期系统可能给出最佳的并发症/疗效结果。该系统不需要任何活检，且未包含在不断扩展的靶向分子治疗中重要的所有预测因素。根据我们的结果，治疗HCC的小分子药物在低分化肿瘤中可能效果更好。手术在高分化肿瘤中更有效。在治疗前不容易获得所有相关信息。一些因素需要进行大体活检（手术活检）。在BCLC B期和C期，预处理检查可能需要强制进行活检以获取信息。这为可使用某些特定微小RNA的液体活检开辟了一条道路。
