2012 EASL-EORTC. Brief introduction to 2012 EASL-EORTC Clinical Practice Guidelines on the management of hepatocellular carcinoma

Transcript

1 264 Infect Dis Info, Vol. 25, No. 5, October 30, EASL-EORTC 2011 R735.7 A (2012) Brief introduction to 2012 EASL-EORTC Clinical Practice Guidelines on the management of hepatocellular carcinoma QU Jian-hui, SU Shu-hui Liver Cancer Treatment and Research Center, 302 Hospital of PLA, Beijing , China [Abstract] EASL-EORTC Clinical Practice Guidelines on the management of hepatocellular carcinoma () developed by European Association for the Study of the Liver and European Organisation for Research and Treatment of Cancer at the end of 2011 gives advice for the surveillance, diagnosis, staging system, molecular classification and therapeutic strategies for patients in order to provide practical guidence for physicians, patients, health -care providers and health -policy makers according to evidence -based medicine. [Key words] carcinoma, hepatocellular; guidebooks; therapeutics 2001 European Association for the Study of the Liver, EASL 58%~89% 90% hepatocellular carcinoma, [1] 10 63% EASL European AFP γ- Organisation for Research and Treatment of Can- DCP AFP-L3 /AFP α- cer, EORTC AFU -3GPC3 AFP [2] [3] 1 DCP WHO AFP HCV 1.3 [4] 6 6 AFP - 37% ~4 Child-Pugh A B C 1 cm 2 2HBV F cm 1

2 Infect Dis Info, Vol. 25, No. 5, October 30, 2012 <1 cm 1~2 cm >2 cm 4 4 CT/ 4 CT/ / [3] 1 Figure 1 Diagnostic algorithm and recall policy for [3] [9] 2 CD34 CK19 EpCAM EASL 3 2 cm 2 EASL-EORTC 1 AFP 400 ng/ml Barcelona clinic liver cancer, BCLC EASL American Association for the Study of Liver Diseases, AASLD 2 cm 1 1~ 2 cm 2 CT BCLC 5 0 A B C D [7] AFP AASLD 1 CT N1 M1 Child-Pugh [8] 1~2 cm 1 Eastern Cooperative 10% 2 Oncology Group, ECOG [9] 2.2 ECOG GPC3 70HSP70 GPC3 LYVE1 survivin [10-11] BCLC B K19 Ep- BCLC A 2 CAM CD34 [12-14] GPC3 sorafenib 68%~72% 4 92% [11 15] 105 HSP70 GPC3 GS 10 72%100% 2 [11] 2 Wnt 2

3 266 Infect Dis Info, Vol. 25, No. 5, October 30, A~C D Child-Pugh A PST 0 Child-Pugh A~B PST 0~2 Child-Pugh C PST >2 0 A <2 cm 3 3 cm PST 0 B PST 0 N1 M1 PST 1~2 C D 3 3 cm / PEI/RF TACE 30%~40% OS> %~70% 2 20% 40% 10% OS 20 14~45 OS 116~14 OS <3 PST. PEI. RFA. TACE. OS. BCLC (2011) [8] Figure 2 Updated BCLC staging system and treatment strategy (2011) [8] S1-TGF-beta S2-EpCAM %~80% [22] 2 cm 5 66% 5% 40% 5 2~5 cm 52%5 cm 37% [23] 30%~50% [16-17] 5 57% 3 26% 5 60% 5 2%~3% 10% [18-19] 50% % 3%~5% 20 20% 2 cm 30%~60%2~ 80%~90% 10% [23] 5 cm 60%~90% 5 cm % 15 min 2 10 mmhg1 mmhg=0.133 kpa cm portal vein embolization, PVE 3 cm [20-21] 20% 1% PVE [24]

4 Infect Dis Info, Vol. 25, No. 5, October 30, cm 90% 2~3 cm 70% 70% 15% 3~5 cm 50% cm 3% 10% 30% PEI 20% 3 cm 43% 4 2 cm RFA PEI PEI Child Pugh A RFA 3~ AFP 5 cm 3 3 cm 200 ng/ml 15 ng/ml/ Child-Pugh B 2 T1 2 cm 3 cm 50% BCLC A RFA ra- diofrequency ablation, RFA 5.4 transcather arterial chemoembolization, TACE [25-26] - T2 6 TACE cm 2~3 4.5 cm 8 cm 5%~10% Child-Pugh A B7 7 3~4 2 1 TACE living donor liver transplantation, LDLT 5%5.5 40% LDLT LDLT 6-7 LDLT LDLT percutaneous ethanol injection, PEI [27]

5 268 Infect Dis Info, Vol. 25, No. 5, October 30, 2012 Child-Pugh A BCLC C Childma in HCV cirrhosisj Pugh B nodules in cirrhosisj. Hepatology, 2007, 45(3): pact on prognosis and response to therapyj Child-Pugh B 15(2): (1): [14] Durnez A, Verslype C, Nevens F, et al. The clinicopathological and prognostic relevance of cytokeratin 7 and 19 expression in hepato-. Histopa- 56 cellular carcinoma. A possible progenitor cell originj thology, 2006, 49(2): risk of liver resectionj. J Am Coll Surg, 2000, 191(1): [1] Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the LiverJ. J Hepatol, 2001, 35(3): [2] National Cancer Institute. Levels of evidence for adult and pediatric cancer treatment studies (PDQ?)[EB/OL]. [ ]. HealthProfessional/page1. [3] European Association for the study of the liver; European Organisation for research and treatment of cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma J. J Hepatol, 2012, 56(4): [4] Singal AG, Volk ML, Jensen D, et al. A sustained viral response is associated with reduced liver -related morbidity and mortality in patients with hepatitis C virusj. Clin Gastroenterol Hepatol, 2010, 8(3): [5] Lok AS, Seeff LB, Morgan TR, et al. Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver diseasej. Gastroenterology, 2009, 136(1): [6] Marrero JA, Su GL, Wei W, et al. Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in American patientsj. Hepatology, 2003, 37(5): [7] Bruix J, Sherman M. Management of hepatocellular carcinomaj. Hepatology, 2005, 42(5): [8] Bruix J, Sherman M. Management of hepatocellular carcinoma: an updatej. Hepatology, 2011, 53(3): [9] International Consensus Group for Hepatocellular Neoplasia. Pa - thologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia J. Hepatology, 2009, 49(2): [10] Llovet JM, Chen Y, Wurmbach E, et al. A molecular signature to discriminate dysplastic nodules from early hepatocellular carcino-. Gastroenterology, 2006, 131(6): [11] Di Tommaso L, Franchi G, Park YN, et al. Diagnostic value of HSP70, glypican 3, and glutamine synthetase in hepatocellular [12] Roskams T. Anatomic pathology of hepatocellular carcinoma: im -. Clin Liver Dis, 2011, [13] Roskams T, Kojiro M. Pathology of early hepatocellular carcinoma: conventional and molecular diagnosisj. Semin Liver Dis, 2010, [15] Capurro M, Wanless IR, Sherman M, et al. Glypican -3: a novel serum and histochemical marker for hepatocellular carcinomaj. Gastroenterology, 2003, 125(1): [16] Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual [17] Lang H, Sotiropoulos GC, D 觟 mland M, et al. Liver resection for hepatocellular carcinoma in non-cirrhotic liver without underlying viral hepatitisj. Br J Surg, 2005, 92(2): [18] Poon RT, Fan ST, Lo CM, et al. Extended hepatic resection for hepatocellular carcinoma in patients with cirrhosis: is it justified? J. Ann Surg, 2002, 236(5): [19] Ishizawa T, Hasegawa K, Aoki T, et al. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinomaj. Gastroenterology, 2008, 134(7): [20] Makuuchi M, Sano K. The surgical approach to : our progress and results in JapanJ. Liver Transpl, 2004, 10(2 Suppl 1):S46- S52. [21] Farges O, Belghiti J, Kianmanesh R, et al. Portal vein embolization before right hepatectomy: prospective clinical trialj. Ann Surg, 2003, 237(2): [22] Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinomaj. Semin Liver Dis, 2005, 25(2): [23] Ikai I, Arii S, Kojiro M, et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide surveyj. Cancer, 2004, 101(4): [24] Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosisj. N Engl J Med, 1996, 334(11): [25] Mazzaferro V, Battiston C, Perrone S, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective studyj. Ann Surg, 2004, 240(5): [26] Lu DS, Yu NC, Raman SS, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantationj. Hepatology, 2005, 41(5): [27] Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinomaj. N Engl J Med, 2008, 359(4):