| 虽然医学有了长足的进步和发展，但是原发性肝癌（或称：肝细胞癌，HCC）仍旧排在世界肿瘤死亡率的第三位。而肝细胞癌的研究进展主要集中在最近的50年间。二十世纪五十年代，肝切除术成为治疗肝细胞癌的可行方法。六十年代，乙型肝炎病毒（HBV）和黄曲霉素的发现为肝癌病因学的研究开创了新纪元。七十年代，甲胎蛋白（AFP）测定使早期检测和早期切除无临床症状的肝癌成为了可能。而且使肝癌切除术后生存率明显提高。八十年代，乙肝疫苗的使用为预防乙型肝炎及其乙肝所致肝癌提供了有效的途径。到九十年代，肝移植成为另外一种可以治疗部分肝细胞癌的新方法为人们所接受。医学的不断发展引起了医学成像的突破和射频肿瘤切除术的出现。肝动脉栓塞化疗则是用于不能切除的肝癌的替代治疗方法。新的二十一世纪初，生物学、分子生物学将在肝细胞癌的认识和治疗中起到重要作用。分子水平的诊断和分期将用于肝癌的临床治疗。肝癌的侵袭性程度也将成为肝癌手术指征及影响预后的重要因素。在肝癌治疗方面，微创手术的概念将会得到广泛的接受。为了提高远期术后存活率，肿瘤转移将成为今后研究的一个重点。肝癌转移是一个涉及多个基因和多步骤的过程。是癌细胞、微环境以及患者遣传特征等因素相互作用的结果。细胞介导免疫反应被抑制有可能是导致乙肝相关肝癌的危险因素。综上，众多的诊断和治疗方法需要相当长的时间才能够运用到临床实际工作中，所以，采用包括预防和有效的治疗乙型和丙型肝炎，肝癌的早期检查和早期治疗的综合策略仍旧是我们当前强调的重点。
Hepatocellular carcinoma – review and prospect
ZHAO-YOU TANG
Liver Cancer Institute & Zhongshan Hospital, Fudan University, Shanghai, China
Primary liver cancer (mostly hepatocellular carcinoma, HCC) remains the third highest cancer killer in the world (Parkin et al 2005). Progress on studies of HCC have been made in the recent half century. In 1950s, anatomical hepatectomy was acknowledged the curable treatment for HCC. In 1960s, the discovery of hepatitis B virus (HBV) and aflatoxin have opened a new era for thestudy of HCC etiology; liver transplantation provided another curable outcome for a part of HCC, which was accepted in 1990s. In 1970s, The AFP assay has led to the early detection and early resection of subclinical HCC, and resulted in marked improvement in survival after surgery . In 1980s, HB vaccine has provided an approach for prevention of HBV and prevent HBV-related HCC; advances in physics have resulted in the breakthrough of medical imaging and opened a new treatment area of tumor ablation using radiofrequency and others. Transcatheter arterial chemoembolization and others are alternatives for treatment of unresectable HCC. In early 21 st century, it is predicted that biology, molecular biology will play an important role to the understanding and management of HCC. For diagnosis, molecular diagnosis and staging will be added. Indication for and prognosis after HCC surgery will be determined also by parameters of HCC invasiveness. For management, the concept of minimally invasive surgery will be widely accepted. In order to improve long-term survival following surgery, metastasis is an important issue to be studied. HCC metastasis is a multigene involved, multistep process, and influenced by interaction between cancer cell, microenvironment, and host genetics.Diminished cell-mediated immune response appears to be an important risk determinant of HBV-related HCC carcinogenesis. Since translation into clinical practice will take decades, a combined strategy including primary prevention using HB vaccine and effective treatment of HBV and HCV, secondary prevention by early detection and early treatment remains to be emphasized.
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