改善肝癌预后关注背景治疗ppt课件.ppt

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1、关注背景治疗改善肝癌预后1目录肝炎/肝硬化是肝细胞癌的重要危险因素合并肝炎/肝硬化对肝细胞癌预后的影响肝细胞癌合并肝炎/肝硬化的治疗TherelationshipofHepatitis/Cirrhosis/HCCTheinfluenceofcoexistingHepatitis/CirrhosisonHCCOutcomeTheprincipleofHCCpatientswithHepatitis/Cirrhosismanagement2肝炎/肝硬化是肝细胞癌的重要危险因素Part13原发性肝细胞癌(HCC)是全球第七大常见癌症全球每年报道600000例HCC

2、患者，其中亚洲约占78%Hepatocellularcarcinoma(HCC)istheseventhmostcommoncancerandthirdleadingcauseofcancer-relateddeathintheworldaccordingtotheNat.Rev.Gastroenterol.Hepatol.7,448–458(2010);publishedonline13July2010亚洲欧洲大洋洲非洲拉丁美洲和地中海区域南美GloboCan2008report.Hepatocellularcarcinoma(HCC)isthe7thm

3、ostcommoncancerAsiancountriesaccountfornearly78%oftheroughly600000casesofhepatocellularcarcinoma(HCC)reportedgloballyeachyear.4肝病三部曲肝细胞癌肝炎(主要为病毒性)肝硬化15-20%在5年内发展至肝硬化患者的HCC年发病率约为3-6%MedClinNAm89(2005)371–389NEnglJMed.1997Dec11;337(24):1733-45HCCmaydevelopatanannualincidenceof3-6%inc

4、irrhosis5肝炎类型概述肝炎类型抗原相应的抗体病毒类型AHAVAnti-HAVRNABHBsAgHBcAgHbeAgAnti-HBsAnti-HBcAnti-HBeDNACHCAgAnti-HCVRNADHDAgAnti-HDV缺陷RNAEHEAgAnti-HEVRNAGHGAgNARNA其他SystemicRegional自身免疫性肝炎病毒性肝炎HAVHBVHCVHDVHEVHGV酒精性肝炎药物性肝炎肝炎69.74%in19927.18%in20062008年，病毒性肝炎仍然是中国第一位的传染病，年发病数140.7万全国每年死于与乙肝相关肝病近30万

5、例中国乙肝病毒感染现状7HBeAg+(wild)HBeAg-/抗-HBe+ALTHBV-DNA正常或轻CHB中重度CHB中重度CHB正常或轻度CHB肝硬化非活动性携带状态HBeAg–慢乙肝HBeAg+慢乙肝免疫耐受期免疫清除期免疫控制期再活动期肝硬化109-1010cp/ml104-108cp/ml<103cp/ml>103cp/ml非活动肝硬化慢性HBV感染自然史慢性HBV携带者8慢性HBV自然史MayoClinProc.2007;82(8):967-975LiverInternational2005:25:472–489MedClinNAm89(2005

6、)371–389免疫耐受HBeAg+DNA↑↑↑ALT正常HBeAg+慢性肝炎HBeAg+DNA↑↑ALT异常发展至肝硬化非活动性携带者HBeAg-DNA↓↓ALT正常HBeAg-慢性肝炎HBeAg-DNA↑ALT异常分别有23%和4.4%的HBeAg-肝炎患者进展为肝硬化和HCCHCCBothchronichepatitisB–andC–associatedHCCusuallyoccurwithcirrhosis.ForhepatitisC,cirrhosisispresentinover90%ofcases,whereasforhepatitisBitr

7、angesfrom50%to70%ofcases.50~70%9MapsweregeneratedusingincidenceratesoflivercancerfromGLOBOCAN2002全球78%的HCC归因于HBV/HCV感染PerzJF,ArmstrongGL,FarringtonLA,etal.ThecontributionsofhepatitisBvirusandhepatitisCvirusinfectionstocirrhosisandprimarylivercancerworldwide.JHepatol2006;45:529-538.

8、57%ofcirrhosiswasattributa