Hepatocellular carcinoma(HCC),commonly known as primary liver cancer,is a major cause of malignant tumors and cancer-related deaths in China,accounting for approximately 85%of all cancer cases in the country.Several g...Hepatocellular carcinoma(HCC),commonly known as primary liver cancer,is a major cause of malignant tumors and cancer-related deaths in China,accounting for approximately 85%of all cancer cases in the country.Several guidelines have been used to diagnose and treat liver cancer.However,these guidelines provide a broad definition for classifying advanced liver cancer,with an emphasis on a singular approach,without considering treatment options for individual patients.Therefore,it is necessary to establish a comprehensive and practical expert consensus,specifically for China,to enhance the diagnosis and treatment of HCC using the Delphi method.The classification criteria were refined for Chinese patients with HCC,and the corresponding optimal treatment regimen recommendations were developed.These recommendations took into account various factors,including tumor characteristics,vascular tumor thrombus grade,distant metastasis,liver function status,portal hypertension,and the hepatitis B virus replication status of patients with primary HCC,along with treatment prognosis.The findings and rec-ommendations provide detailed,scientific,and reasonable individualized diagnosis and treatment strategies for clinicians.展开更多
Background:The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for hepatocellular carcinoma(HCC)with fibrosis/cirrhosis is often associated with limited growth of future liver remnant...Background:The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for hepatocellular carcinoma(HCC)with fibrosis/cirrhosis is often associated with limited growth of future liver remnant(FLR).We introduced a new procedure named transcatheter arterial embolization-salvaged ALPPS(TAE-salvaged ALPPS)which was shown to be especially suitable for HCC patients with cirrhosis or fibrosis who failed adequately to respond to conventional ALPPS.The short-term efficacy and safety for the TAE-salvaged ALPPS on patients with HCC and fibrosis/cirrhosis were studied.Methods:Consecutive HCC patients who underwent TAE-salvaged ALPPS in our hospital between November 2016 and June 2020 were retrospectively studied.The new ALPPS procedure included conventional ALPPS stage-1 using associating liver partition and portal vein ligation.When FLR failed to reach sufficient hypertrophy,TAE was carried out 2 weeks later followed by liver resection 3 weeks after ALPPS stage-1.Results:Nine of 10 patients had a single tumor(median diameter 14.0 cm,range,5.2-17 cm).The remaining patient had multiple tumors(diameter of one tumor 14.0 cm,and two satellite foci 2.0 and 3.0 cm).R0 resection was achieved in all patients(100%)after a median of 21 days.Six patients had cirrhosis,1 had METAVIR grade-3 fibrosis,and 3 had METAVIR grade-2 fibrosis.The median increase in FLR volume after TAE-salvaged ALPPS was 69.7%(34.4-143.9%).The absolute and relative kinetic growth rates(KGRs)were 9.9(7.1-17.3)mL/day and 3.4%(1.9-7.2%)/day,respectively.The median absolute KGRs were 15.7,2.6,and 19.5 mL/day in the first,second,and third postoperative weeks after ALPPS stage-1,respectively.The rapid increase in KGR on the third week was induced by TAE.The overall postoperative morbidity rates were 50,0%(5/10),20.0%(2/10)and 70.0%(7/10)after ALPPS stage-1,TAE and ALPPS stage-2,respectively.The 90-day mortality rate was 10.0%(1/10).The median overall survival was 40 months.Conclusions:The new TAE-salvaged ALPPS induced significant increases in FLR volumes within 3 weeks in patients with HCC and fibrosis/cirrhosis.The procedure is promising in treating patients with HCC and fibrosis/cirrhosis who fail to achieve sufficient FLR hypertrophy after conventional ALPPS stage-1.展开更多
In the past decade,great progress has been made in the systemic therapies of hepatocellular carcinoma(HCC),represented by the target therapies and immune checkpoint inhibitors(ICIs).In the Imbrave 150 trial,one in ten...In the past decade,great progress has been made in the systemic therapies of hepatocellular carcinoma(HCC),represented by the target therapies and immune checkpoint inhibitors(ICIs).In the Imbrave 150 trial,one in ten patients reached complete response(CR)with medical treatment alone(according to HCC-specific modified RECIST;mRECIST)(1).If different systemic regimes were combined with loco-regional therapies,the chance of achieving CR was even higher.These findings promoted the practice of conversion surgery in HCC(2,3).After tumors were converted and resected,a subgroup of HCC reached its pathological CR(pCR).Similar results were also observed in the latest pioneering trials of neoadjuvant ICIs therapies in HCC(4).展开更多
The COVID-19 pandemic remains complex,with concentrated and sporadic cases in multiple locations.During COVID-19 outbreaks,the routine diagnosis and treatment of liver cancer patients can be affected to a significant ...The COVID-19 pandemic remains complex,with concentrated and sporadic cases in multiple locations.During COVID-19 outbreaks,the routine diagnosis and treatment of liver cancer patients can be affected to a significant degree.For liver oncologists,it is important to identify strategies and protocols to reduce the risk of COVID-19 infection among patients and medical staff,use limited medical resources to maximally ensure access to anti-tumor treatment and related emergency treatment,and provide support for patients during the disruption caused by the pandemic.Given this requirement,eleven experts in liver cancer treatment-related disciplines from Zhongshan Hospital,Fudan University have written the Expert Guidance on the Overall Management of Liver Cancer During the COVID-19 Pandemic,which aims to provide a reference to assist liver oncologists in conducting clinical work safely and effectively while implementing COVID-19 prevention and control strategies and offer guidance on supporting liver cancer patients during the pandemic.展开更多
基金funded by the National Natural Science Foundation of China(No.82272956).
文摘Hepatocellular carcinoma(HCC),commonly known as primary liver cancer,is a major cause of malignant tumors and cancer-related deaths in China,accounting for approximately 85%of all cancer cases in the country.Several guidelines have been used to diagnose and treat liver cancer.However,these guidelines provide a broad definition for classifying advanced liver cancer,with an emphasis on a singular approach,without considering treatment options for individual patients.Therefore,it is necessary to establish a comprehensive and practical expert consensus,specifically for China,to enhance the diagnosis and treatment of HCC using the Delphi method.The classification criteria were refined for Chinese patients with HCC,and the corresponding optimal treatment regimen recommendations were developed.These recommendations took into account various factors,including tumor characteristics,vascular tumor thrombus grade,distant metastasis,liver function status,portal hypertension,and the hepatitis B virus replication status of patients with primary HCC,along with treatment prognosis.The findings and rec-ommendations provide detailed,scientific,and reasonable individualized diagnosis and treatment strategies for clinicians.
基金This work was supported by grants from the National Natural Science Foundation of China(No.82150004).
文摘Background:The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for hepatocellular carcinoma(HCC)with fibrosis/cirrhosis is often associated with limited growth of future liver remnant(FLR).We introduced a new procedure named transcatheter arterial embolization-salvaged ALPPS(TAE-salvaged ALPPS)which was shown to be especially suitable for HCC patients with cirrhosis or fibrosis who failed adequately to respond to conventional ALPPS.The short-term efficacy and safety for the TAE-salvaged ALPPS on patients with HCC and fibrosis/cirrhosis were studied.Methods:Consecutive HCC patients who underwent TAE-salvaged ALPPS in our hospital between November 2016 and June 2020 were retrospectively studied.The new ALPPS procedure included conventional ALPPS stage-1 using associating liver partition and portal vein ligation.When FLR failed to reach sufficient hypertrophy,TAE was carried out 2 weeks later followed by liver resection 3 weeks after ALPPS stage-1.Results:Nine of 10 patients had a single tumor(median diameter 14.0 cm,range,5.2-17 cm).The remaining patient had multiple tumors(diameter of one tumor 14.0 cm,and two satellite foci 2.0 and 3.0 cm).R0 resection was achieved in all patients(100%)after a median of 21 days.Six patients had cirrhosis,1 had METAVIR grade-3 fibrosis,and 3 had METAVIR grade-2 fibrosis.The median increase in FLR volume after TAE-salvaged ALPPS was 69.7%(34.4-143.9%).The absolute and relative kinetic growth rates(KGRs)were 9.9(7.1-17.3)mL/day and 3.4%(1.9-7.2%)/day,respectively.The median absolute KGRs were 15.7,2.6,and 19.5 mL/day in the first,second,and third postoperative weeks after ALPPS stage-1,respectively.The rapid increase in KGR on the third week was induced by TAE.The overall postoperative morbidity rates were 50,0%(5/10),20.0%(2/10)and 70.0%(7/10)after ALPPS stage-1,TAE and ALPPS stage-2,respectively.The 90-day mortality rate was 10.0%(1/10).The median overall survival was 40 months.Conclusions:The new TAE-salvaged ALPPS induced significant increases in FLR volumes within 3 weeks in patients with HCC and fibrosis/cirrhosis.The procedure is promising in treating patients with HCC and fibrosis/cirrhosis who fail to achieve sufficient FLR hypertrophy after conventional ALPPS stage-1.
基金This work was supported by the Key Research and Development Program of Shandong(Major Science&Technology Innovation Project),2021SFGC0501.
文摘In the past decade,great progress has been made in the systemic therapies of hepatocellular carcinoma(HCC),represented by the target therapies and immune checkpoint inhibitors(ICIs).In the Imbrave 150 trial,one in ten patients reached complete response(CR)with medical treatment alone(according to HCC-specific modified RECIST;mRECIST)(1).If different systemic regimes were combined with loco-regional therapies,the chance of achieving CR was even higher.These findings promoted the practice of conversion surgery in HCC(2,3).After tumors were converted and resected,a subgroup of HCC reached its pathological CR(pCR).Similar results were also observed in the latest pioneering trials of neoadjuvant ICIs therapies in HCC(4).
文摘The COVID-19 pandemic remains complex,with concentrated and sporadic cases in multiple locations.During COVID-19 outbreaks,the routine diagnosis and treatment of liver cancer patients can be affected to a significant degree.For liver oncologists,it is important to identify strategies and protocols to reduce the risk of COVID-19 infection among patients and medical staff,use limited medical resources to maximally ensure access to anti-tumor treatment and related emergency treatment,and provide support for patients during the disruption caused by the pandemic.Given this requirement,eleven experts in liver cancer treatment-related disciplines from Zhongshan Hospital,Fudan University have written the Expert Guidance on the Overall Management of Liver Cancer During the COVID-19 Pandemic,which aims to provide a reference to assist liver oncologists in conducting clinical work safely and effectively while implementing COVID-19 prevention and control strategies and offer guidance on supporting liver cancer patients during the pandemic.
