How to prevent primary liver cancer? Key knowledge about primary liver cancer

Prognosis of patients with primary liver cancer

Primary liver cancer is a rapidly progressing malignant tumor. Before the 1970s, the average time from the onset of symptoms to death was 3 to 6 months. A few cases died less than 3 months after the onset of symptoms. There were also individual cases that survived for more than 1 year, and those who survived for more than 5 years were rare. In 1971, Curutchet summarized the literature from 1905 to 1970 worldwide, and there were only 45 cases of liver cancer patients who survived for more than 5 years. Its prognosis is directly related to the clinical type and pathological type. In general, the simple type has the best prognosis in clinical disease types, followed by the cirrhosis type, and the inflammatory type is the worst. In other words, patients with obvious clinical cirrhosis have a poor prognosis, and those with severe liver function damage have an even worse prognosis. The better the degree of differentiation of cancer cells, the better the prognosis. Patients with single nodules, small liver cancers, intact capsules, no cancer thrombi, or a large number of lymphocyte infiltration around cancer cells have a better prognosis; those who undergo radical resection and whose AFp drops to normal values ​​after surgery also have a good prognosis. In short, the main factors that determine the prognosis of liver cancer are the biological characteristics of the tumor and the host's disease resistance, both of which change with the development of the disease. Therefore, if primary liver cancer can be detected, diagnosed and treated early, the prognosis of liver cancer will definitely be further improved. In recent years, the survival rate of liver cancer patients has increased significantly. Among the 1,450 cases of liver cancer hospitalized at the Liver Cancer Institute of Shanghai Medical University from 1958 to 1990, 125 cases have survived for more than 5 years. This result depends to a large extent on the radical resection, secondary resection and resection of recurrence after surgery of liver cancer. The progress of surgical treatment is always based on diagnostic technology and comprehensive treatment. The detection of alpha-fetoprotein, B-ultrasound and CT are the prerequisites for the early detection of small liver cancer, and radical resection of small liver cancer is an important way to improve the overall 5-year survival rate of liver cancer. Statistics from the Liver Cancer Research Institute of Shanghai Medical University show that from 1958 to 1993, there were 514 cases of small liver cancer, of which 474 underwent surgical resection, with a surgical mortality rate of 1.7% (the main cause of death was hepatic encephalopathy and liver and kidney failure), a 5-year survival rate of 63.8%, a 10-year survival rate of 46.8%, and the longest survival of 36 years. Resection of small liver cancer has the best effect. If the liver cancer that cannot be removed is reduced and then removed, a 5-year survival rate of 60.8% can be obtained. The surgical mortality rate of patients with resectable large liver cancer is less than 5%, and the 5-year survival rate after radical resection is 40%. Factors that affect prognosis include the early or late stage of the disease, tumor location, treatment method, pathological type, and biological characteristics of the tumor. Here we only discuss the factors that affect prognosis related to resection.

1. Scope of resection Radical resection is significantly better than palliative resection. Cancer cells pass through the portal vein system to cause intrahepatic metastasis. If the tumor is extensively and regularly removed along the Glisson system, recurrence will be reduced and the prognosis will be better. In fact, most patients are accompanied by cirrhosis. Excessive resection will inevitably cause liver function to be difficult to compensate and increase surgical mortality. Therefore, in this case, surgeons propose limited liver resection, that is, resection of liver cancer together with 1 cm of cancer-free liver tissue around the cancer. However, some people believe that radical resection is only considered when the liver tangent is 1 to 2 cm away from the edge of the cancer. Yoashida found that resection of 1 cm or less of cancer-free liver tissue is enough, and postoperative recurrence has nothing to do with the distance of the resection edge; when the tumor is larger than 4 cm, even if the liver is resected 1 cm away from the cancer edge, recurrence cannot be prevented.

2. It is indisputable that portal vein tumor thrombus is an important factor affecting prognosis. The recurrence rate after resection of patients with tumor thrombus is higher than that of patients without tumor thrombus, and the prognosis is poor.

3. Perioperative blood transfusion is generally believed to have an adverse effect on the patient's prognosis. The transfusion group had a longer hospital stay, more severe liver enzyme disorders, and higher fever rates and complications. This effect may be the result of immunosuppression caused by blood transfusion. Sitzmann's study believed that the adverse effects of blood transfusion were related to the amount of blood transfusion. Patients who received 4.0 units of blood transfusion had no complications, and those who received more than 4.0 units of blood transfusion had complications. Yamamoto followed up 252 patients with liver cancer resection and found that 144 cases had liver cancer recurrence, of which 74.3% (n=55) were in the blood transfusion group, which was significantly higher than the non-transfusion group (50.5%, n=89). Therefore, some people believe that perioperative blood transfusion is likely to promote postoperative recurrence of hepatocellular carcinoma. This issue needs to be confirmed by more studies.

4. Tumor location: Hepatic hilar (central) liver cancer has a worse prognosis after resection than peripheral liver cancer. Data from the Liver Cancer Research Institute of Shanghai Medical University show that the 1-, 3-year survival rates after resection of hepatic hilar liver cancer are 65.7%, 45.3%, and 38.3%, respectively, which are significantly lower than the 1-, 3-, and 5-year survival rates of peripheral liver cancer resection in the same period (93.8%, 86.1%, and 80.1%). This may be because hepatic hilar liver cancer is close to large blood vessels, and cancer cells spread earlier in the liver through the blood circulation. In addition, due to its close proximity to large blood vessels, the scope of resection is also limited.

5. Tumor size: The overall prognosis of large liver cancer after resection is not as good as that of small liver cancer. This may be because large liver cancer has already broken through the capsule during its growth process, and the liver cancer cells have already spread into the liver.

For small liver cancer with severe cirrhosis, local radical resection instead of traditional liver lobectomy can effectively improve the surgical resection rate, reduce the surgical mortality rate, and achieve good long-term efficacy. Long-term follow-up with AFp and B-ultrasound after surgery can detect early recurrence of liver cancer, take effective treatment measures in time, and prolong the patient's survival. Treatments such as arterial chemoembolization can shrink the tumor before secondary resection. A comprehensive treatment model combining surgical treatment, chemotherapy, radiotherapy, traditional Chinese medicine treatment, and immune biological treatment can improve the patient's survival. Despite this, there are still many problems, such as the cause of primary liver cancer is still unclear. There is a lack of effective preventive measures; the early diagnosis of AFp-negative small liver cancer has not been completely solved; there is no good treatment for liver cancer with cirrhosis and multi-center occurrence; the postoperative recurrence rate is still high, and the long-term efficacy is still unsatisfactory; there is no drug that has little systemic reaction to patients and has a special effect on liver cancer; how to scientifically and rationally apply comprehensive therapy; liver cancer invades blood vessels and causes intrahepatic dissemination, etc. These problems affect the prognosis of liver cancer and need to be studied and solved as soon as possible.