肝癌研究的变迁与趋势

Studies on liver cancer: evolution and perspectives

半个世纪以来肝癌研究发生了很大变迁,概述了主要变迁和今后趋势。(1)肝癌高危险因素已变为HBV与HCV感染、环境因素、生活方式、代谢内分泌和遗传因素,由此须调整预防措施。(2)美国、意大利和作者单位资料表明,肝癌预后的改善主要由于早诊早治,并继续成为提高疗效的重要途径。(3)保守治疗格局在变,分子靶向治疗是一个趋势。"杀癌+杀癌"的联合治疗仍有发展空间,而"杀癌+改造"的模式更值得关注。(4)癌转移观念已有更新,如转移乃全身性问题,转移不是晚期现象,免疫炎症微环境影响转移,转移主要与肿瘤干细胞有关,转移潜能可双向变。为此应重视全身性干预,包括神经、免疫、内分泌、代谢等;关注肿瘤干细胞的"改邪归正";关注抗炎剂的应用;关注中医中药。(5)杀癌疗法负面问题的干预是提高现有疗法疗效的一条捷径。"变"是绝对的,"不变"是相对的,站得高一点,看的远一点,有助推动事物发展。

Great changes have taken place in the studies on liver cancer over the past 50 years. The main evolution and perspectives are re viewed as follows ： （ 1 ） Infections with hepatitis B virus and hepatitis C virus, environmental factors, lifestyle, and metabolic, endocrine, and hereditary factors have become the high - risk factors for liver cancer, so the preventive measures should be adjusted. （2）The research data from the USA, Italy, and the author＇ s institute showed that early diagnosis and early treatment are the main contributors to improved prognosis of liver cancer, and they remain the important means for improving treatment outcome. （ 3 ） Conservative therapy is being trans formed, and molecular targeted therapy is a direction in the future ; ＂tumor - killing ＋ tumor - killing＂ combination therapy still holds prom ise for application, while ＂tumor - killing ＋ rehabilitation＂ modality is worth more attention. （4） The concept of cancer metastasis has been updated： metastasis is a systemic problem; metastasis is not a phenomenon in the advanced stage; the microenvironment of immune inflam mation is an important factor for cancer metastasis ; cancer metastasis is mainly related to tumor stem cells ; the metastatic potential of cancer can be increased or decreased. Therefore, we should pay attention to the systemic intervention involving the nervous, immune, endocrine, and metabolic systems, tumor stem cells＇ ＂return to the right way＂, the application of anti - inflammatory agent, and traditional Chinese medicine. （5） Intervention of the adverse effects of tumor - killing therapy is an easy way to improve treatment outcome. ＂Evolution＂ is ab solute, while ＂constancy＂ is relative. We should be far -sighted to promote the treatment of liver cancer.