内科学教学课件：Hepatocellular carcinoma.ppt

n 5-y OS transplantation 468 75.7% surgical resection samll liver cancer 5059 57.0% large liver cancer 4860 30.3% Transarterial chemoembolization Percutaneous ethanol injection Radiofrequency ablation RFA for HCC Small HCC treated with radiofrequency ablation（zhongshan hospital n=864) ≤5cm: Medial survival 42m 5-year survaval rate: 34.7% ≤3cm: Medial survival 62m 5-year survval rate：50.6% P0.0001 * * * * * * * * * * * * * * * * Hepatocellular carcinoma Epidemiology HCC is the seventh most common cancer worldwide, and the third leading cause of cancer-related deaths. More than 600,000 new cases worldwide annually (50% in China) Over 80% of HCCs occur in developing countries sub-Saharan Africa, southeast Asia, and east Asia Incidence decreased in developing countries and increased in developed countries Yang JD, et al. Nature Rev 2010 Global variation in incidence of HCC Yang JD, et al. Nature Rev 2010 Etiology Hepatitis B: ?50% HCC attributed to HBV worldwide Around 100 times higher for incidence of HCC in carriers than non carriers Hepatitis C: leading cause of HCC in Western countries and Japan Aflatoxin B: synergistic factor with HBV in China and sub-Saharan Africa Alcoholic liver disease: second most common risk factor for HCC after HCV in USA Nonalcoholic steatohepatitis (NASH): an emerging risk factor in developed countries Prevention Vaccination of HBV Reduced HCC incidence after universal vaccination of newborn babies Lamivudine treatment reduced incidence of HCC in hepatitis B or resultant cirrhosis Prevention of HCV transmission No vaccination for HCV Infection control measures in high risk practices (screening blood donors, use of disposable needles, thorough sterilization of surgical instruments) Interferon and ribavirin for hepatitis C Pathology of HCC Differentiation Edmondson grade: I, II, III, IV Portal