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Liver cancer is mainly composed of hepatocellular carcinoma originating from liver cells, intrahepatic cholangiocarcinoma (ICC) originating from intrahepatic bile duct cells, and mixed hepatocellular cholangiocarcinoma (CHC)
.
Cirrhosis of the liver and chronic hepatitis B without antiviral treatment are the main causes of liver cancer in China
.
The recently released "Guidelines for Stratified Screening and Surveillance of Primary Liver Cancer (2020 Edition)" provide guidance for scientifically identifying high-risk groups of liver cancer and stratified monitoring
.
Recommendation 1: Liver cancer screening and monitoring should be included in the national public health plan, aiming to reduce liver cancer-related deaths and overall liver disease-related deaths (C1).
Recommendation 2: The age of onset of liver cancer in China is gradually Increasing; the age-adjusted incidence rate is declining year by year, but the burden of disease caused is still increasing (A1).
Etiology of liver cancer Recommendation 3: Chronic hepatitis B is the main cause of hepatocellular carcinoma (A1).
Alcohol.
The incidence of liver cancer in patients with metabolic-related diseases is increasing year by year (B1).
Aflatoxin B1 increases the risk of hepatitis B virus (HBV) infection and the risk of liver cancer in patients with alcoholic liver disease (A1).
Recommendation 4: Caused by various reasons Liver cirrhosis is an important link in the occurrence of liver cancer.
Chronic HBV-related cirrhosis is the leading cause of hepatocellular carcinoma in China (A1).
Identification and stratification of high-risk populations for liver cancer.
Recommendations for liver cancer screening and detection tools 9: Abdominal ultrasound examination combined with serum A Fetoprotein (AFP) is a first-line tool for liver cancer monitoring (A1).
Recommendation 10: Serum AFP combined with AFP-L3 and antagonist II-induced protein (PIVKA-II) detection can improve the detection rate of early liver cancer (B2) ｡Recommendation 11: Among people at high risk of liver cancer, Gd-EOB-DTPA enhanced MRI can improve the treatment of hyperplastic nodules in cirrhosis, low-grade dysplastic nodules (LGND) and high-grade atypical nodules The ability to identify hyperplastic nodules (HG-ND) significantly improves the detection rate of early liver cancer (B1).
Recommendation 12: Liquid biopsy and other new liver cancer serum markers, whether alone or in combination, can be used for liver cancer screening and monitoring The serum index of the liver cancer still lacks sufficient clinical evaluation and strict verification, and is not recommended for routine screening and monitoring (C1).
Recommendations for liver cancer monitoring 13: For people with low risk of liver cancer, routine monitoring is performed once a year or more (C2); People at intermediate risk of liver cancer, once a year (C1); people at high risk of liver cancer, routine surveillance every 6 months (A1); people at very high risk of liver cancer, 3 months 1Routine monitoring, with enhanced CT or MRI once every 6 to 12 months, to improve the diagnosis rate of early liver cancer (B1).
Recommendation 14: Patients with decompensated cirrhosis have a higher risk of liver cancer.
Monitoring liver cancer in these patients is also It can prolong survival time and improve the priority waiting level and prognosis of liver transplantation, and reduce the overall mortality rate of liver cirrhosis (C2).
Recommendation 15: There are still some obstacles in screening and monitoring of liver cancer, and the whole course of management in the progression of chronic liver disease to liver cancer Among them, popular science education, WeChat or telephone interviews can improve the compliance of screening and monitoring (C1).
Recommendation 16: Only in the target population with sufficient risk of liver cancer and sufficient sample size, the implementation of liver cancer stratification Surveillance plan may show its cost-effectiveness (C1).
Recommendations for monitoring after radical liver cancer surgery 17: For patients after radical treatment of liver cancer, refer to the monitoring of very high-risk populations for liver cancer within 2 years, and routine monitoring for 3 months, using enhanced CT Or MRI can detect early recurrence and metastasis of liver cancer (C1); more than 2 years, please refer to the monitoring of high-risk groups of liver cancer, 6-month routine monitoring (C1).
Recommendation 18: Effective antiviral therapy can reduce the recurrence and metastasis of HBV-related liver cancer (B1) Entecavir, tenofovir disoproxil fumarate and tenofovir disoproxil fumarate are first-line antiviral drugs for chronic hepatitis B, which can prevent the recurrence and metastasis of HBV-related liver cancer (B1 ).
Recommendation 19: Small molecule anti-angiogenesis and other targeted drugs as single agents or combined with immune checkpoint inhibitors are used for the treatment of inoperable liver cancer (A1) and the prevention of liver cancer recurrence and metastasis after radical treatment (C2 ).
The above content is extracted from: Professional Committee of Hepatobiliary and Pancreatic Disease Prevention and Control of Chinese Preventive Medicine Association, etc.
Guidelines for the hierarchical screening and monitoring of primary liver cancer (2020 edition)[J].
Chinese Journal of Cancer Prevention and Treatment, 2021, 28( 2): 83-99.
For the original text, please see "Read the original text"For the original text, please see "Read the original text"For the original text, please see "Read the original text"
.
Cirrhosis of the liver and chronic hepatitis B without antiviral treatment are the main causes of liver cancer in China
.
The recently released "Guidelines for Stratified Screening and Surveillance of Primary Liver Cancer (2020 Edition)" provide guidance for scientifically identifying high-risk groups of liver cancer and stratified monitoring
.
Recommendation 1: Liver cancer screening and monitoring should be included in the national public health plan, aiming to reduce liver cancer-related deaths and overall liver disease-related deaths (C1).
Recommendation 2: The age of onset of liver cancer in China is gradually Increasing; the age-adjusted incidence rate is declining year by year, but the burden of disease caused is still increasing (A1).
Etiology of liver cancer Recommendation 3: Chronic hepatitis B is the main cause of hepatocellular carcinoma (A1).
Alcohol.
The incidence of liver cancer in patients with metabolic-related diseases is increasing year by year (B1).
Aflatoxin B1 increases the risk of hepatitis B virus (HBV) infection and the risk of liver cancer in patients with alcoholic liver disease (A1).
Recommendation 4: Caused by various reasons Liver cirrhosis is an important link in the occurrence of liver cancer.
Chronic HBV-related cirrhosis is the leading cause of hepatocellular carcinoma in China (A1).
Identification and stratification of high-risk populations for liver cancer.
Recommendations for liver cancer screening and detection tools 9: Abdominal ultrasound examination combined with serum A Fetoprotein (AFP) is a first-line tool for liver cancer monitoring (A1).
Recommendation 10: Serum AFP combined with AFP-L3 and antagonist II-induced protein (PIVKA-II) detection can improve the detection rate of early liver cancer (B2) ｡Recommendation 11: Among people at high risk of liver cancer, Gd-EOB-DTPA enhanced MRI can improve the treatment of hyperplastic nodules in cirrhosis, low-grade dysplastic nodules (LGND) and high-grade atypical nodules The ability to identify hyperplastic nodules (HG-ND) significantly improves the detection rate of early liver cancer (B1).
Recommendation 12: Liquid biopsy and other new liver cancer serum markers, whether alone or in combination, can be used for liver cancer screening and monitoring The serum index of the liver cancer still lacks sufficient clinical evaluation and strict verification, and is not recommended for routine screening and monitoring (C1).
Recommendations for liver cancer monitoring 13: For people with low risk of liver cancer, routine monitoring is performed once a year or more (C2); People at intermediate risk of liver cancer, once a year (C1); people at high risk of liver cancer, routine surveillance every 6 months (A1); people at very high risk of liver cancer, 3 months 1Routine monitoring, with enhanced CT or MRI once every 6 to 12 months, to improve the diagnosis rate of early liver cancer (B1).
Recommendation 14: Patients with decompensated cirrhosis have a higher risk of liver cancer.
Monitoring liver cancer in these patients is also It can prolong survival time and improve the priority waiting level and prognosis of liver transplantation, and reduce the overall mortality rate of liver cirrhosis (C2).
Recommendation 15: There are still some obstacles in screening and monitoring of liver cancer, and the whole course of management in the progression of chronic liver disease to liver cancer Among them, popular science education, WeChat or telephone interviews can improve the compliance of screening and monitoring (C1).
Recommendation 16: Only in the target population with sufficient risk of liver cancer and sufficient sample size, the implementation of liver cancer stratification Surveillance plan may show its cost-effectiveness (C1).
Recommendations for monitoring after radical liver cancer surgery 17: For patients after radical treatment of liver cancer, refer to the monitoring of very high-risk populations for liver cancer within 2 years, and routine monitoring for 3 months, using enhanced CT Or MRI can detect early recurrence and metastasis of liver cancer (C1); more than 2 years, please refer to the monitoring of high-risk groups of liver cancer, 6-month routine monitoring (C1).
Recommendation 18: Effective antiviral therapy can reduce the recurrence and metastasis of HBV-related liver cancer (B1) Entecavir, tenofovir disoproxil fumarate and tenofovir disoproxil fumarate are first-line antiviral drugs for chronic hepatitis B, which can prevent the recurrence and metastasis of HBV-related liver cancer (B1 ).
Recommendation 19: Small molecule anti-angiogenesis and other targeted drugs as single agents or combined with immune checkpoint inhibitors are used for the treatment of inoperable liver cancer (A1) and the prevention of liver cancer recurrence and metastasis after radical treatment (C2 ).
The above content is extracted from: Professional Committee of Hepatobiliary and Pancreatic Disease Prevention and Control of Chinese Preventive Medicine Association, etc.
Guidelines for the hierarchical screening and monitoring of primary liver cancer (2020 edition)[J].
Chinese Journal of Cancer Prevention and Treatment, 2021, 28( 2): 83-99.
For the original text, please see "Read the original text"For the original text, please see "Read the original text"For the original text, please see "Read the original text"
