肝癌早期诊断及治疗--Morris Sherman教授专访

文章导读：实际上只有一种早期发现肝癌的方法，就是定期进行超声检查。许多地方对血液肿瘤标志物进行检测如甲胎蛋白以便能早期发现肿瘤，但问题是肿瘤越小，甲胎蛋白或其它标志物阳性的可能性也越小。如果真的想早期发现小肿瘤，那么真正需要使用的最敏感的检测方法就是超声。

Hepatology Digest:  Early detection of HCC is obviously very important for the treatment and prognosis of HCC.  Can you give us some of your suggestion and summarized for us some of the latest research related to how we can detect HCC early on?

国际肝病：显然早期发现肝癌对于治疗和预后十分重要。您能否给我们一些建议或对最新关于肝癌早期诊断的研究给我们做一些总结？

Professor  Morris Sherman:  There is really only one way to detect HCC early and that is to do regular ultrasound screening.  Many places use blood tests such as alpha fetoprotein in an attempt to identify tumors but the problem is that the smaller the tumor, the less likely it is that the alpha-fetoprotein or any of the other markers is going to be positive.  If you really want to find the smallest, earliest tumor then you really need to use the most sensitive test available, and that is the ultrasound.  It should be applied regularly, every six months.  There is really no benefit from using alternating strategies, which some people use, of ultrasound and alpha fetoprotein at six month intervals.  The idea really is that you use your most sensitive test and apply it at the appropriate intervals.

Professor  Morris Sherman:  实际上只有一种早期发现肝癌的方法，就是定期进行超声检查。许多地方对血液肿瘤标志物进行检测如甲胎蛋白以便能早期发现肿瘤，但问题是肿瘤越小，甲胎蛋白或其它标志物阳性的可能性也越小。如果真的想早期发现小肿瘤，那么真正需要使用的最敏感的检测方法就是超声。应该定期进行检测，如每6个月检查一次。一些医生使用每6个月进行超声和甲胎蛋白交替检查的策略，其实没什么益处。正确的做法是使用最敏感的检查方法，并间隔适当的时间。

Hepatology Digest:  In addition to alpha fetoprotein, are there any other useful markers for early detection of HCC?

国际肝病：除甲胎蛋白外，还有没有其它对肝癌的早期诊断有用的标志物？

Professor  Morris Sherman:   There are other markers that are used.  The PIVKA-2 or AFPL-3 are other markers that are often used, but really their effectiveness in the early detection of cancers, or screened cancers, has not been demonstrated.  There is a good deal of data to suggest that they are not very good markers because alpha fetoprotein and these other two markers are also more common and more commonly expressed in advanced cancers.  There is just not good in having a screening test, which detects advanced cancers because you are not going to be able to cure a large number of them.  You really want a screening test which is going to pick up curable cancers, and those markers really don’t meet that criterion.

Professor  Morris Sherman:  还有其它的标志物。如PIVKA-2或AFPL-3是目前经常使用的标志物，但实际上它们在早期发现癌症中的效果还没有得到证实。有大量的研究表明它们并不是很好的标志物，因为甲胎蛋白和其他两个标志物也仅仅在晚期癌症表达更加常见。如果一个检测仅仅能检测到晚期肿瘤，那么这就不是一个很好的检测，因为很多晚期肿瘤患者根本无法治愈。我们真正需要的是能够早期筛选出可治愈的肿瘤的检测方法，而这些标志物均未达到这样的标准。

Hepatology Digest:  When it comes to the most effective treatment for early HCC, among surgical, non-surgical, radio frequency ablation therapy, etc.  Can you talk a little about which you might currently favor? And why?

国际肝病：关于早期肝癌最有效的治疗方法，如手术，非手术，射频消融治疗等等。您能谈一下您比较倾向于选择哪种治疗方法？为什么？

Professor  Morris Sherman:   Depending on where you are in the world the optimal treatment of choice is different.  For instance, in Japan these lesions are treated with chemoemobilization whereas most other places in the world reserve chemoembolization for more advanced tumors.  The optimal treatments are probably resection and radio frequency ablation.  The kinds of patients that are suitable for these two treatments are not necessarily the same, although there is some overlap.  Really what you want to be able to do is to get rid of the tumor completely which resection can certainly do.  There are patients whose liver disease is sufficiently advanced that resection is not possible.  Those cases are obviously candidates for radio frequency ablation.  There are patients who may be candidates for radio frequency ablation but have a lesion that is not accessible or likely not to be fully ablated and are obviously surgical candidates.  There are also patients who could go either way.

Professor  Morris Sherman:  世界上不同地区最佳的首选治疗是不同的。例如，在日本早期HCC常常选择化疗栓塞治疗，而其他大多数地方化疗栓塞常常用于治疗更晚期的肿瘤患者。最佳的治疗可能是切除术和射频消融。适合这两种治疗的患者其病情并不一定相同，尽管有一些重叠。真正要做的是彻底切除肿瘤，而根治术可以做到这一点。有些患者肝脏疾病已经发展到晚期，手术切除是不可能的。显然这些患者适合进行射频消融。有些患者虽然适合射频消融治疗但可能存在无法完全消融的病灶，显然此时适合手术治疗。也有患者任何一种治疗都可以。

Hepatology Digest:  There has been some progress in HCC screening with more patients being diagnosed early so there are many changes and challenges in clinical practice.  Could you give us a brief introduction on what is new in clinical practice, some of the changes you’ve observed, and any progress you think has come or will come in the future?