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CCHIO 国际视野丨陈敏山教授:整合医学理念与多学科协作是肝癌诊治的关键

作者:肿瘤瞭望   日期:2023/11/10 15:42:52  浏览量:3126

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2023年11月16~19日,由中国抗癌协会主办、天津医科大学肿瘤医院等单位承办的2023中国整合肿瘤学大会(CCHIO)将于天津举办。本次会议将继续秉承“肿瘤防治,赢在整合”主题,汇聚国内外抗肿瘤力量,共述前沿学术成果。《肿瘤瞭望》特邀采访了中山大学肿瘤防治中心肝脏外科主任、中山大学肝癌研究所所长陈敏山教授,请他介绍我国肝癌的流行趋势及诊治现状,并就“肿瘤防治,赢在整合”理念以及中国特色肝癌转化治疗等话题发表其独到见解。

编者按:2023年11月16~19日,由中国抗癌协会主办、天津医科大学肿瘤医院等单位承办的2023中国整合肿瘤学大会(CCHIO)将于天津举办。本次会议将继续秉承“肿瘤防治,赢在整合”主题,汇聚国内外抗肿瘤力量,共述前沿学术成果。《肿瘤瞭望》特邀采访了中山大学肿瘤防治中心肝脏外科主任、中山大学肝癌研究所所长陈敏山教授,请他介绍我国肝癌的流行趋势及诊治现状,并就“肿瘤防治,赢在整合”理念以及中国特色肝癌转化治疗等话题发表其独到见解。
 
Editor’s Note:The 2023 Chinese Congress on Holistic Integrative Oncology(CCHIO),organized by the China Anti-Cancer Association and hosted by Tianjin Medical University Cancer Hospital,will take place in Tianjin from November 16th to 19th,2023.This conference will continue to uphold the theme of"Cancer Prevention and Control:Success through Integration,"attracting anti-cancer experts and professionals from around the world to share cutting-edge academic achievements."Oncology Frontier"had the privilege of interviewing Professor Chen Minshan,Director of Liver Surgery at the Sun Yat-sen University Cancer Center and Director of the Sun Yat-sen University Liver Cancer Institute,to discuss the current trends and treatment of liver cancer in China and to share his unique insights on the concept of"Cancer Prevention and Control:Success through Integration"and China’s unique approach to liver cancer transformation therapy.
 
01
《肿瘤瞭望》:能否介绍一下我国肝癌的流行趋势和诊疗现状?
 
"Oncology Frontier":Can you please introduce the current trends and the state of diagnosis and treatment of liver cancer in China?
 
陈敏山教授:我国肝癌的防治形势仍相当严峻。肝癌是目前我国第4位常见恶性肿瘤及第2位肿瘤致死病因,严重威胁我国人民的生命和健康。我国每年大约有接近40万新发肝癌患者,约占全球新发肝癌患者总数的一半。肝癌具有发病率高、死亡率高的特点,患者就诊时大多为中晚期,因此许多患者在就诊时已失去根治性手术治疗的机会。同时,我国的肝癌约有80%是由乙肝病毒感染引起的,此类患者通常合并不同程度的肝炎、肝硬化,因此治疗难度极大。所以,在治疗方面,临床不应以外科为主,而是应该在外科为主的基础上发展多学科治疗。这是当前我国肝癌的整体流行趋势和诊疗现状。
 
Professor Minshan Chen:The situation of liver cancer prevention and treatment in China remains quite challenging.Liver cancer is currently the fourth most common malignant tumor and the second leading cause of cancer-related deaths in China,posing a serious threat to the lives and health of the Chinese population.China has approximately 400,000 new cases of liver cancer each year,accounting for about half of the global total.Liver cancer is characterized by a high incidence and high mortality rate,and most patients are diagnosed at an advanced stage,where patients are mostly ineligible for curative surgical treatment.Moreover,about 80%of liver cancer cases in China are caused by hepatitis B virus infection,and these patients often have varying degrees of hepatitis and cirrhosis,making treatment very challenging.Therefore,clinical practice should not be predominantly surgery-based but should instead develop into multidisciplinary treatments based on surgery.This is the current overall trend and treatment status of liver cancer in China.
 
02
《肿瘤瞭望》:“肿瘤防治,赢在整合”是中国抗癌协会坚持的癌症防治理念,您认为在肝癌的诊疗实践中,如何体现这一整合医学的理念?
 
"Oncology Frontier":"Cancer Prevention and Control:Success through Integration"is the cancer prevention and control concept advocated by the China Anti-Cancer Association.How do you think this concept of integrated medicine can be applied in the diagnosis and treatment of liver cancer?
 
陈敏山教授:正如中国抗癌协会理事长樊代明院士所提出的,“肿瘤防治,赢在整合”意味着肿瘤的防治工作不能依靠单一手段或单一学科,而是把多学科的先进理念与临床实践整合到一起。“肿瘤防治,赢在整合”要求医护人员不能局限于“防”和“治”,而是要从“防”、“筛”、“诊”、“治”、“康”五个方面践行整合理念。“防”,即预防,降低肿瘤的发病率;“筛”,即筛查,通过肿瘤筛查及早发现肿瘤,进而实现早期的“诊”和“治”;在诊断和治疗之后,还要重视“康”,即患者的康复。目前,在国内的肿瘤治疗中,康复领域的临床实践还是有所欠缺的,这也提示我们在治疗肿瘤的过程中,要注意多阶段的协同发展,将多学科力量整合到一起,进行综合治疗,充分发挥整合医学的优势,使患者获益最大化。
 
Professor Minshan Chen:As proposed by Academician Fan Daiming,Chairman of the China Anti-Cancer Association,"Cancer Prevention and Control:Success through Integration"means that the prevention and control of cancer should not rely on single methods or disciplines but should integrate advanced multidisciplinary concepts and clinical practices."Cancer Prevention and Control:Success through Integration"requires healthcare professionals not to focus solely on"prevention"and"treatment"but to implement the integration concept in five aspects:"prevention,""screening,""diagnosis,""treatment,"and"rehabilitation.""Prevention"aims to reduce the incidence of cancer through preventive measures."Screening"involves early detection of tumors through screening,leading to early"diagnosis"and"treatment."After diagnosis and treatment,attention should also be paid to"recovery"or"health"to ensure patients’well-being.Currently,clinical practice in cancer treatment in China should emphasize all five aspects,and we should pay attention to multi-stage a coordinated development,integrate multidisciplinary strengths for comprehensive treatment,and leverage the advantages of integrated medicine to maximize patient benefits.
 
03
《肿瘤瞭望》:我国肝癌以中晚期居多,在肝癌综合治疗下,可以使患者获得手术转化。请您介绍一下具有中国特色的肝癌转化治疗。
 
"Oncology Frontier":Liver cancer in China is mostly diagnosed at an advanced stage.In comprehensive liver cancer treatment,patients can undergo transformational surgery.Can you introduce China’s unique approach to liver cancer conversion chemotherapy?
 
陈敏山教授:正如我们刚刚提到的,我国约有80%的肝癌患者在就诊时已处于中晚期,失去了手术切除的机会。如果能够早期发现肝癌并立即进行手术治疗,那么患者将在创伤更少、费用更低的情况下获得更好的治疗效果;而如果无法进行手术治疗,患者则需要在治疗过程中反复接受介入和药物治疗,治疗次数多、费用高,疗效往往也不甚理想,既往此类经过多重治疗患者的5年生存率甚至接近于0。
 
如今,我们中国医生提出了“转化治疗”的概念,也就是说通过前期的转化治疗,为初始不可切除肝癌患者创造潜在手术切除机会,通过手术切除,患者的疗效得到了极大提升。在此方面,国内常用的方法有很多,传统的介入方法是栓塞化疗,尽管这种方法可以杀灭肿瘤,但肿瘤缩小不明显。近年来,中山大学肿瘤防治中心开发了一种新的肝动脉灌注化疗方法,采用的药物是国内指南推荐的mFOLFOX方案,而不是日本、韩国、希腊等国家所采用的顺铂方案,我们通过研究发现该方法的疗效良好,能够更多、更快地缩小肿瘤体积,使得肿瘤能够从不可切除转化为可切除。在此方面我们中心进行了多项相关研究,目前也正在向全国同行进行推广。
 
此外,我们也进行了药物治疗方面的探索。近年来药物治疗领域也获得了许多新进展,肝癌药物治疗也已经进入到了靶免联合的时代,通过药物的联合治疗使患者的疗效得到了提升。现在,我们拥有肝动脉化疗、靶免药物治疗等多种方法,许多中晚期肝癌患者也因此获得了手术切除的机会。当然,为了进一步规范转化治疗的临床实践,我们国内肝癌领域的专家在樊嘉院士的带领下,编写了《肝癌转化治疗中国专家共识(2021版)》,近期也将进行第二版的修订、发布工作,以更好地指导国内基层医生的肝癌转化治疗。这些具有中国特色的肝癌转化治疗方案是国内治疗先进性的体现,相信这些方案也是非常值得国际同行去借鉴的。
 
Professor Minshan Chen:As we mentioned earlier,about 80%of liver cancer patients in China are already at an advanced stage when diagnosed,and they have lost the opportunity for surgical resection.Early detection and immediate surgical treatment can provide patients with better treatment outcomes with less trauma and lower costs.If surgical treatment is not possible,patients may need multiple interventions and drug treatments,resulting in higher costs and often suboptimal outcomes.In fact,the five-year survival rate for such patients who have undergone multiple treatments can be close to zero.
 
Now,Chinese doctors have introduced the concept of"conversion chemotherapy,"which means creating potential opportunities for surgical resection through early-stage transformation therapy for initially inoperable liver cancer patients.By achieving surgical resection,patients’outcomes have significantly improved.In this regard,there are many commonly used methods in China.Traditional intervention methods include transarterial chemoembolization,which,while effective in killing cancer,may not significantly reduce tumor size.In recent years,the Sun Yat-sen University Cancer Center has developed a new method of hepatic arterial infusion chemotherapy using the mFOLFOX regimen recommended in the national guidelines,rather than the cisplatin regimen used in countries such as Japan,South Korea,and Greece.Our research has shown that this method is highly effective in rapidly reducing tumor size,allowing previously inoperable tumors to become operable.In this area,our center has conducted multiple related studies,and we are currently promoting this method among our colleagues nationwide.
 
Additionally,we have explored drug treatments.In recent years,there have been significant developments in the field of drug therapy,and liver cancer drug treatment has entered the era of targeted immunotherapy.By combining drug treatments,patients’outcomes have improved.Currently,we have various methods available,including hepatic arterial chemoembolization,targeted immunotherapy,and more.As a result,many late-stage liver cancer patients have gained the opportunity for surgical resection.To further standardize the clinical practice of conversion chemotherapy,experts in the field of liver cancer in China,led by Academician Fan Jia,have published the"Chinese Expert Consensus on Liver Cancer Transformation Therapy(2021 Edition),"and a second edition is underway.These unique approaches to liver cancer conversion chemotherapy in China represent the forefront of treatment,and I believe they are worth emulating by international peers.
 
04
《肿瘤瞭望》:中国抗癌协会肝癌专业委员会主委,您对我国肝癌诊疗和研究的发展有何期待?
 
"Oncology Frontier":As the Chairman of the China Anti-Cancer Association’s Liver Cancer Professional Committee,what are your expectations for the development of liver cancer diagnosis,treatment,and research in China?
 
陈敏山教授:首先,我认为最重要的是早诊早治,因为这才是真正能够提高中国肝癌治疗效果的重要方法。我们在前面也多次提到中晚期患者的治疗费用高、次数多、疗效欠佳,尽管部分患者能够达到转化切除标准,但其整体疗效仍然是不及早期患者的。如今,腹腔镜技术以及局部消融技术均已广泛应用,临床经验相当丰富,早期肝癌患者在经过规范化治疗后能到达到5年、10年甚至20年的生存期。所以,我们不断强调要进行早诊早治,但目前国内公众对此的意识还不够充足,很多人不愿意进行每年一次的健康体检,乙肝病毒携带者也很难保持每半年一次的体检。作为临床医生,我们反复通过书籍、报纸等各种渠道向公众宣传早诊早治的重要性,但公众认知水平的提升需要一个过程,对此还需要我们广大临床医生不懈的努力,通过量的积累逐步提升公众的健康意识。
 
其次,我希望肝癌的治疗能够广泛推行多学科协作模式。肝癌的治疗不是单一学科的问题,需要外科、移植、介入、消融、靶向药物治疗、放疗、化疗等多种方法进行有机结合,所以临床需要成立一个围绕肝癌治疗的多学科团队。以中山大学肿瘤防治中心为例,我们的外科医生能够进行介入、消融、药物等治疗,熟练掌握多种肝癌的治疗方法,这一点是通过建立以疾病为中心的科室来实现的,我们中心所采用的这一治疗体系也逐渐获得了业界同行的认可和采纳,很多医院也建立了类似的紧密合作的多学科团队,并开展了一系列的临床研究,通过临床研究来发现肝癌的最佳治疗方法。我认为临床医生必须通过大量的临床研究来探索新的治疗方法,我们需要将主要精力放在临床研究中,因为基础研究未必是临床医生所擅长的,我们可以和基础医学领域的研究者进行交叉合作,而不要把过多的精力放在申请自然科学基金上。
 
Professor Minshan Chen:Firstly,I believe that early diagnosis and treatment are of paramount importance,as they are the key to improving the effectiveness of liver cancer treatment in China.As we mentioned earlier,the high cost,high frequency,and suboptimal outcomes of treatment for late-stage patients necessitate a focus on early diagnosis and treatment.Advanced laparoscopic techniques and local ablation methods are now widely used,and clinical experience is abundant.Early-stage liver cancer patients can achieve a 5-year,10-year,or even 20-year survival period after standardized treatment.Therefore,we continually stress the importance of early diagnosis and treatment.However,public awareness in China is not yet sufficient,and many people are unwilling to undergo annual health check-ups.Hepatitis B carriers also find it challenging to maintain half-yearly check-ups.As clinical doctors,we repeatedly promote the importance of early diagnosis and treatment to the public through various channels such as books and newspapers.Elevating public awareness is a gradual process,and it requires relentless efforts from clinical doctors.Through the accumulation of experience,we aim to enhance the public’s health consciousness.
 
Secondly,I hope that the treatment of liver cancer can widely adopt a multidisciplinary collaborative approach.The treatment of liver cancer is not a matter of a single discipline but requires the integration of various methods such as surgery,transplantation,intervention,ablation,targeted drug therapy,radiotherapy,chemotherapy,and more.Clinical practice should establish multidisciplinary teams centered around liver cancer treatment.Taking the Sun Yat-sen University Cancer Center as an example,our surgeons are proficient in intervention,ablation,and drug therapy,mastering various methods for liver cancer treatment.This is achieved by establishing departmental structures focused on specific diseases.Our center’s treatment system has gradually gained recognition and acceptance in the field.Many hospitals have established similar closely cooperating multidisciplinary teams and have carried out a series of clinical studies to discover the best treatment methods for liver cancer.I believe that clinical doctors must explore new treatment methods through extensive clinical research.We should invest our efforts in clinical research because basic research is not necessarily the expertise of clinical doctors.We can collaborate with researchers in the field of basic medicine rather than devoting too much effort to applying for natural science funds.

 

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