Hepatocelulární karcinom - prognostická kritéria individualizované léčby

Title in English Hepatocellular carcinoma - prognostic criteria of individualized treatment


Year of publication 2022
Type Article in Periodical
Magazine / Source Klinicka Onkologie
MU Faculty or unit

Faculty of Medicine

Web Časopis Klinická onkologie
Doi http://dx.doi.org/10.48095/ccko2022100
Keywords drug resistance; predictive oncology; hepatocellular carcinoma; bio psy; tailored treatment; P-450 cytochrome; isoform
Description Background: Though the sixth most frequent malignancy, hepatocellular carcinoma (HCC) is the third most common cause of death amongst solid tumours. Only surgery in the early stages may provide the cure; however, HCC still has a high recurrence rate. Non-surgical treatment lacks comparable effi cacy. It was not sooner than in 2017 that the therapy galore started to extend. Thus prognostic factors driving the therapy have been gaining importance. Material and methods: All relevant literature was checked for aetiology, epidemiology, dia gnostic means, and individualised treatment of HCC. Cytochrome P-450 expression data from 22 patients operated in the University Hospital Brno in the period 2017–2020 were included. Results: Screening the population at risk (presence of cirrhosis) with the transabdominal ultrasound lies at the centre of the dia gnostic algorithm. Making the dia gnosis does not require a bio psy in most cases. Only a few parameters are thus known before the treatment – a size and number of lesions, and AFP level. These drive the indication to surgery. Relapses after surgery and response to palliative treatment depend on the expression of MET and AXL that directly aff ect anti-VEGF therapy. High AFP predicts a good response to regorafenib but early relapse after surgery. The pattern of P450 expression was found linked with tumour diff erentiation. The diff erentiation correlates with the size and number of lesions. We also found a link between the P450 expression and some mi-RNAs possibly detectable using liquid bio psy techniques. Conclusion: The share of deaths from HCC overweighs its incidence. The risk population to screen is well-defi ned (cirrhosis). The BCLC staging system probably gives the best complication/effi cacy results. This system does not require any bio psy and does not comprise all predictive factors important in the expanding targeted molecular therapy. According to our results, small molecules to treat HCC should work better in poorly diff erentiated tumours. Surgery is more eff ective in those well-diff erentiated. It isn‘t easy to get all relevant information before therapy. Some factors need macrobio psy (surgical). The pretreatment workup will probably require a mandatory bio psy in BCLC B and C stages to get the information. This opens up a way for the liquid bio psy that could use some specifi c mi RNAs.

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