我国原发性肝癌筛查的现状、挑战及发展方向

Current status,challenges and future directions for hepatocellular carcinoma surveillance in China

2020年,全球原发性肝癌是第6位最常见的恶性肿瘤,全球新诊断病例90.57万,而由原发性肝癌导致的死亡率高居恶性肿瘤致死第3位,合计约83万,总体死亡率为8.7/10万。2020年,亚洲地区新增原发性肝癌65.7万例,死亡60.9万例,分别占全球的72.5%、73.3%。2020年,我国新增原发性肝癌患者41万例,死亡39.1万例,死亡率为17.2/10万,高居恶性肿瘤致死的第2位。全球每年近半数的原发性肝癌新发病例及死亡病例发生在我国,疾病负担沉重。肝细胞癌(hepatocellular carcinoma,HCC)占原发性肝癌的75%~85%。我国的HCC患者由于确诊时大多处于中晚期,年龄标化的5年生存率仅为14.1%,预后极差。HCC早诊率低是导致患者治疗效果差的重要原因之一,而提高HCC早诊率的关键在于进行有效的HCC筛查。传统的“腹部超声+血甲胎蛋白检测”的筛查手段,远不能满足临床筛查早期HCC的需求,存在筛查执行率低、对早期HCC筛查的灵敏度低、肝癌基础病因变化对HCC筛查形成了新的挑战等问题。为优化HCC筛查效果、改善患者预后,应对策略需从患者及医护等多角度入手提高HCC筛查的执行率,开发准确率更高、便捷性更好的新型HCC筛查手段[如GALAD(gender,age,AFP-L3,DCP,AFP)评分、液体活检等],提倡“个体化”筛查的策略,分层富集和精准筛查,优化医疗资源使用的成本效益比。作为个体化筛查策略之一的“数字化”赋能闭环肝病精细化管理及HCC筛查是创新模式,也是我国管理应对策略的选择之一。

In 2020,primary liver cancer ranked as the sixth most common malignancy worldwide,with 905700newly-diagnosed cases,and 830000 deaths with an overall mortality rate of 8.7/100000,ranking third in in malignant tumors.In Asia,there were 657000 newly-diagnosed cases and 609000 deaths,accounting for 72.5%and 73.3%of the global burden,respectively.In China,primary liver cancer is one of the most common malignant tumors,with 410000 new cases,and 391000 deaths with a mortality rate of 17.2/100000,ranking the second highest among the causes of cancer deaths.Approximately half of annual global newly-diagnosed cases and deaths of liver cancer occurred in China,leading to an extremely heavy disease burden.Hepatocellular carcinoma(HCC)accounts for 75%-85%of primary liver cancer.The 5-year survival rate of HCC patients is merely 14.1%in China,mainly due to advanced disease stage at the diagnosis in most HCC patients.The low rate of diagnosis of early-stage HCC is one of the most important reasons for the poor treatment outcome of HCC patients.The key to improving the diagnosis of early-stage HCC lies on the effective HCC surveillance.The current surveillance method of“abdominal ultrasound+alpha-fetoprotein”is far from meeting the clinical needs in detecting early-stage HCC,which is faced with many problems,including low implementation rates of HCC screening,poor sensitivity for early-stage HCC,and new challenges posed by profound changes in the underlying etiologies of hepatocellular carcinoma in the past decade.In order to optimize the efficacy of HCC surveillance and improve the prognosis of HCC patients,we must adopt effective strategies,raise the implementation rate of HCC surveillance from the perspectives of patients and healthcare professionals,develope new HCC surveillance tools of higher accuracy and with more convenience,[GALAD(gender,age,AFP-L3,DCP,AFP)score and liquid biopsy];advocating“individualized”surveillance strategies,stratified enrichment and precise screening to maximize the cost-effectiveness of healthcare resources.As one innovative model for individualized HCC surveillance,“artificial intelligence”in closed-loop precise liver disease management may serve as a strategic choice for disease management in China.