Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected pa...Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.展开更多
Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40–70% patients eventually suffer from postoperative recurrence within 5 years...Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40–70% patients eventually suffer from postoperative recurrence within 5 years. HCC recurrence after surgery severely affects prognosis of the patients. Nevertheless, there is an opportunity to improve patients' prognosis if doctors and researchers can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Hence, based on our own experience and published studies from other researchers, we develop this consensus regarding multidisciplinary management of locally recurrent and metastatic hepatocellular carcinoma after resection. This consensus consists of the entire course of recurrent hepatocellular carcinoma (RHCC) management, including prediction of recurrence, prevention, diagnosis, treatment and surveillance of RHCC. Consensus recommendations are presented with grades of evidences (Ia, Ib, IIa, IIb, III and IV), and strength ofrecommendations (A, B, C, D and E). We also develop a decision-making path for RHCC treatment, which can intuitively demonstrate the management for RHCC. It is hoped that we may make some effort to standardize the management of RHCC and ultimately understand how to improve outcomes.展开更多
Recent studies have demonstrated the potential of natural killer(NK)cells in immunotherapy to treat multiple types of cancer.NK cells are innate lymphoid cells that play essential roles in tumor surveillance and contr...Recent studies have demonstrated the potential of natural killer(NK)cells in immunotherapy to treat multiple types of cancer.NK cells are innate lymphoid cells that play essential roles in tumor surveillance and control that efficiently kill the tumor and do not require the major histocompatibility complex.The discovery of the NK’s potential as a promising therapeutic target for cancer is a relief to oncologists as they face the challenge of increased chemo-resistant cancers.NK cells show great potential against solid and hematologic tumors and have progressively shown promise as a therapeutic target for cancer immunotherapy.The effector role of these cells is reliant on the balance of inhibitory and activating signals.Understanding the role of various immune checkpoint molecules in the exhaustion and impairment of NK cells when their inhibitory receptors are excessively expressed is particularly important in cancer immunotherapy studies and clinical implementation.Emerging immune checkpoint receptors and molecules have been found to mediate NK cell dysfunction in the tumor microenvironment;this has brought up the need to explore further additional NK cell-related immune checkpoints that may be exploited to enhance the immune response to refractory cancers.Accordingly,this review will focus on the recent findings concerning the roles of immune checkpoint molecules and receptors in the regulation of NK cell function,as well as their potential application in tumor immunotherapy.展开更多
A 70-year-old female was admitted to the hospital with a history of chills and fever (with a high temperature of 37.5 ℃) for 17 days. No obvious anomalies were detected on physical examination. Laboratory tests indic...A 70-year-old female was admitted to the hospital with a history of chills and fever (with a high temperature of 37.5 ℃) for 17 days. No obvious anomalies were detected on physical examination. Laboratory tests indicated white blood cells (6.96×109/L), neutrophil percentage (65%), C-reactive protein, and procalcitonin (0.766 ng/mL) in the normal range. The tests for liver function were normal, with Child-Pugh grade A, and the patient tested negative for hepatitis B virus infection.展开更多
A 22-year-old woman noted a fist-sized mass on her upper abdomen 1 month previously.She had occasional fever.Abdominal computed tomography(CT)and magnetic resonance imaging(MRI)revealed a huge lesion in the left lobe ...A 22-year-old woman noted a fist-sized mass on her upper abdomen 1 month previously.She had occasional fever.Abdominal computed tomography(CT)and magnetic resonance imaging(MRI)revealed a huge lesion in the left lobe and intrahepatic metastasis(Panels A,B).展开更多
A 14-year-old girl presented with right upper abdominal swelling for two months.Physical examination revealed palpable hepatomegaly.Her laboratory analysis revealed a mild anemia(HGB:108 g/L).The tests for liver funct...A 14-year-old girl presented with right upper abdominal swelling for two months.Physical examination revealed palpable hepatomegaly.Her laboratory analysis revealed a mild anemia(HGB:108 g/L).The tests for liver function were normal.The Child-Pugh score was A grade.The tests for hepatitis B and C viruses were negative.The tests for tumor markers such as carcinoembryonic antigen(CEA),α-fetoprotein(AFP),and cancer antigen 19-9(CA19-9)were normal.All other laboratory results were within the normal range.Abdominal ultrasound revealed an oval isoechoic mass in the liver measuring 26.4 cm×25.6 cm×12.6 cm,which was solid,ill-defined and had rich blood flow signals.Contrast-enhanced CT and MRI of the liver demonstrated a huge hepatic mass of 14.4 cm×21.5 cm×22.2 cm,and heterogenous enhancement with central necrosis,which involved all three hepatic veins,the left portal vein and had loss of fat planes with the inferior vena cava(Figure 1A,B).Three-dimensional reconstruction technology revealed that the total hepatic volume was 6,158.3 mL,and the tumor volume was 4,258.68 mL.Furthermore,the standard hepatic volume was 1,105 mL,the remnant liver volume was 1,373 mL(72%),and the indocyanine green clearance test at 15 minutes was 1.2%.展开更多
文摘Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.
基金supported by Chinese Society of Liver Cancer,Chinese Medical Doctor Association and Surgical Technology Innovation and Promotion Association,NAHIEM,ChinaThis work was in part supported by grants from the State Key Scientific and Technological Research Programs(2017ZX10203207-003-0020)the Scientific and Technological Support Project of Sichuan Province(2018SZ0204,2016SZ0025 and 2015SZ0049).
文摘Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40–70% patients eventually suffer from postoperative recurrence within 5 years. HCC recurrence after surgery severely affects prognosis of the patients. Nevertheless, there is an opportunity to improve patients' prognosis if doctors and researchers can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Hence, based on our own experience and published studies from other researchers, we develop this consensus regarding multidisciplinary management of locally recurrent and metastatic hepatocellular carcinoma after resection. This consensus consists of the entire course of recurrent hepatocellular carcinoma (RHCC) management, including prediction of recurrence, prevention, diagnosis, treatment and surveillance of RHCC. Consensus recommendations are presented with grades of evidences (Ia, Ib, IIa, IIb, III and IV), and strength ofrecommendations (A, B, C, D and E). We also develop a decision-making path for RHCC treatment, which can intuitively demonstrate the management for RHCC. It is hoped that we may make some effort to standardize the management of RHCC and ultimately understand how to improve outcomes.
基金funded by the National Natural Science Foundation of China(No.81400659,81974377)Natural Science Fund of Liaoning Province(No.2017225032,20180551193,2020-MS-181)+1 种基金Shenyang Science and Technology Project(No.17-230-9-16)the 345 Talent Project of Shengjing Hospital(No.40B).
文摘Recent studies have demonstrated the potential of natural killer(NK)cells in immunotherapy to treat multiple types of cancer.NK cells are innate lymphoid cells that play essential roles in tumor surveillance and control that efficiently kill the tumor and do not require the major histocompatibility complex.The discovery of the NK’s potential as a promising therapeutic target for cancer is a relief to oncologists as they face the challenge of increased chemo-resistant cancers.NK cells show great potential against solid and hematologic tumors and have progressively shown promise as a therapeutic target for cancer immunotherapy.The effector role of these cells is reliant on the balance of inhibitory and activating signals.Understanding the role of various immune checkpoint molecules in the exhaustion and impairment of NK cells when their inhibitory receptors are excessively expressed is particularly important in cancer immunotherapy studies and clinical implementation.Emerging immune checkpoint receptors and molecules have been found to mediate NK cell dysfunction in the tumor microenvironment;this has brought up the need to explore further additional NK cell-related immune checkpoints that may be exploited to enhance the immune response to refractory cancers.Accordingly,this review will focus on the recent findings concerning the roles of immune checkpoint molecules and receptors in the regulation of NK cell function,as well as their potential application in tumor immunotherapy.
文摘A 70-year-old female was admitted to the hospital with a history of chills and fever (with a high temperature of 37.5 ℃) for 17 days. No obvious anomalies were detected on physical examination. Laboratory tests indicated white blood cells (6.96×109/L), neutrophil percentage (65%), C-reactive protein, and procalcitonin (0.766 ng/mL) in the normal range. The tests for liver function were normal, with Child-Pugh grade A, and the patient tested negative for hepatitis B virus infection.
文摘A 22-year-old woman noted a fist-sized mass on her upper abdomen 1 month previously.She had occasional fever.Abdominal computed tomography(CT)and magnetic resonance imaging(MRI)revealed a huge lesion in the left lobe and intrahepatic metastasis(Panels A,B).
文摘A 14-year-old girl presented with right upper abdominal swelling for two months.Physical examination revealed palpable hepatomegaly.Her laboratory analysis revealed a mild anemia(HGB:108 g/L).The tests for liver function were normal.The Child-Pugh score was A grade.The tests for hepatitis B and C viruses were negative.The tests for tumor markers such as carcinoembryonic antigen(CEA),α-fetoprotein(AFP),and cancer antigen 19-9(CA19-9)were normal.All other laboratory results were within the normal range.Abdominal ultrasound revealed an oval isoechoic mass in the liver measuring 26.4 cm×25.6 cm×12.6 cm,which was solid,ill-defined and had rich blood flow signals.Contrast-enhanced CT and MRI of the liver demonstrated a huge hepatic mass of 14.4 cm×21.5 cm×22.2 cm,and heterogenous enhancement with central necrosis,which involved all three hepatic veins,the left portal vein and had loss of fat planes with the inferior vena cava(Figure 1A,B).Three-dimensional reconstruction technology revealed that the total hepatic volume was 6,158.3 mL,and the tumor volume was 4,258.68 mL.Furthermore,the standard hepatic volume was 1,105 mL,the remnant liver volume was 1,373 mL(72%),and the indocyanine green clearance test at 15 minutes was 1.2%.
