Nzira yekudzivirira kudzokororazve gomarara rechiropa?

Kudzivirira kenza yechiropa

Kudzivirira kudzoka kwekenza yechiropa, kudzivirira kudzoka kwekenza yechiropa mushure mekuvhiyiwa, nzira yekudzivirira kudzoka kwekenza yechiropa, nzira yekudzivirira kudzoka kwekenza yechiropa.

Liver cancer is the second leading cause of cancer death in the world, of which hepatocellular carcinoma (HCC) is the most common type of liver cancer. Globally, nearly half of new cases of liver cancer occur in China. The treatment options for patients with advanced hepatocellular carcinoma are very limited. The currently approved treatment options have a tumarara progression-free survival of about 3-7 months and a total survival of about 9-13 months

Iyo makore mashanu ekupona mwero wekenza yechiropa

The five-year survival rate of patients with gomarara rechiropa is low, according to data from the US ASCO official website:

44% yevarwere vakaonekwa vaine kenza yechiropa-yekutanga uye yavo yemakore mashanu ekupona yaive 5%.

Kana gomarara rechiropa rapararira kumatunhu akakomberedza kana mitezo uye / kana kumatunhu emakiromendi, makore mashanu ekupona mwero ndeye 5%.

Kana gomarara rapararira kure nemuviri, makore mashanu ekupona iri 5%.

Zvisinei, kunyange kana kenza ikawanikwa iri padanho repamusoro, marapirwo akasiyana anogona kushandiswa kubatsira varwere vane gomarara rechiropa kuti vawedzere kurarama kwavo. Kuvhiya ndiyo yakanakisa yekurapa sarudzo yevarwere vane gomarara rechiropa. Vazhinji varwere vanofunga nezvekuvhiya resection kutanga, asi vachiri kusangana nenjodzi yekudzokazve mushure mekuvhiya resection.

Nzira yekudzivirira sei kunyatso kuitika kwekenza yechiropa? 

Kuongorora kwenguva nenguva

Compared with malignant tumors such as breast cancer and mapapu cancer, the recurrence rate of liver cancer is relatively high: Generally, the recurrence rate after three years is about 40% -50%, and the recurrence rate after five years is 60% -70% .

Naizvozvo, zvinodikanwa kuti uongorore nguva dzose uye uteedzere kuraira kwachiremba, kunyangwe kana zviratidzo zvekutanga zvemastastasis zvikawanikwa, kuchine mukana wekudzokerwa zvakare kuvhiya. Kana muviri wese metastases ukawanikwa nekuda kwekuregeredza ongororo, kurapwa kunozove kwakanyanya kuomarara.

Zvinhu zvinoda kuongororwa kuti zviongororwe kenza yenguva dzose zvinosanganisira:

Chiropa basa bvunzo

Kuongororwa kushanda kwechiropa kazhinji ndiko kunonyanya kukwanisa kuona mamiriro echiropa aripo pazvirwere uye kuzvimba, asi kazhinji vanotadza kuona kuvepo kwechiropa uye kenza yechiropa, uye havakwanise kuona kana vakatapukirwa nehutachiona hwehepatitis hwakasiyana.

Alpha fetoprotein

Kana iyo preoperative alpha-fetoprotein yakanaka inoderera kune yakajairwa mushure mekuvhiya kubviswa kwekenza yechiropa, uye ikazowedzera zvakare, hapana tsananguro yechirwere chisingaperi chechiropa, icho chinoratidza kuti gomarara rechiropa rakadzokazve.

Kune varwere vane negative alpha-fetoprotein pamberi pekenza yechiropa resection, alpha-fetoprotein inogona kuve yakanaka panguva yekudzokazve, uye alpha-fetoprotein inofanirwa kuteverwa mushure mekuvhiyiwa.

Abdominal ultrasound

B-ultrasound ine zvakanakira kunzwisisika, nyore, uye yakaderera mutengo. Iyo inzira yakakosha yekutarisa kudzokororazve kwekenza yechiropa. Abdominal ultrasound muyedzo wakakosha

Chifuva radiography

Mamwe maronda anodzokororwa anotanga kuitika mumapapu, saka chipfuva X-rays zvinodiwa kutarisa chipfuva kuti chidzoke zvakare.

CT, PET-CT

Kana chiremba achiri asina chokwadi chekuti achatamisa mushure meB-ultrasound, CT scan inofanira kuitwa nenguva. Kana pane imwe metastasis mune imwe chikamu, ipapo muviri wose PET-CT cheki inoitwa. Varwere vane chirwere chegomarara chechiropa vanogona kuve nePET-CT kuongororwa kamwe pagore kuti vaone mapundu akakura kupfuura 2mm mumuviri wese panguva imwe chete, zvichideredza kuoma uye kusava nechokwadi kwebvunzo dzakawanda.

Chinja mararamiro

Rega doro, rega doro, rega doro, zvinhu zvakakosha zvinotaurwa katatu, unofanira kusiya doro. Uyewo, usasvuta, usanyanyoshanda, uye gara uchifara.

Kudzidzira kwakakodzera, mwedzi 2-3 mushure mekuvhiyiwa, unogona kuita zvinyoro zvishoma, zvakadai sokufamba, uye zvishoma nezvishoma kuwedzera kubva pamaminitsi gumi nemashanu kusvika kumaminitsi makumi mana; iwe unogona zvakare kurovedza muviri qigong, Tai Chi, maekisesaizi eredhiyo uye mamwe maekisesaizi akapfava.

Kunyanya kutariswa kunofanirwa kubhadharwa kuchikafu, usadye chikafu chakaumbwa, bhengi, bhekoni, tofu uye zvimwe zvekudya zvine nitrite, uye usadye mishonga yechinyakare yechiChinese uye zvigadzirwa zvehutano.

Kudya kwemashure mekuvhiya kunonyanya kuve kwakareruka, uye kudyiwa kweprotein yemhando yepamusoro senge jena jena uye nyama isina mafuta inowedzerwa zvakakodzera. Kudya kwemashure mekuvhiya kunowanzo shanduka kubva mumvura, porridge, mukaka, mazai ane steamed, hove, nyama yakasendamira kune chikafu chakajairwa.

Edza kudya chikafu chiri nyore kugaya, nzvenga zvine mafuta, zvinonhuwirira, zvinogumbura, zvakaoma, zvinonamira uye zvimwe zvekudya, idya chikafu chakaringana, idya zvishoma, uye haifanire kuzara.

Nzira yekudzivirira kudzokororazve kenza yechiropa mushure mekuvhiyiwa?

At present, the main treatment options for liver cancer include liver transplantation (liver replacement), liver cancer resection, transcatheter arterial chemoembolization, radiofrequency ablation / microwave ablation, high-intensity focused ultrasound (HIFU), absolute alcohol injection, molecular targets To drugs, etc., while radiotherapy, chemotherapy, and immunotherapy ndiwo marapiro ekuwedzera, kazhinji kwete sehurongwa hwekurapa hukuru.

Kuvhiya kwakachena

Iyo yakanyanya kunaka nzira yekurapwa kwegomarara rechiropa ndeyekubvisa maronda emamota kuzadzisa chinangwa chekurapa kwakanyanya. Kana maitiro ekuvhiya akazadzikiswa, mapundu ese anogona kubviswa nekuvhiya.

Kana paine maronda mazhinji, iyo inopinda nzvimbo iri yakakura, kana metastases iri kure, bundu resection inogona kusarudzwa zvinoenderana nemamiriro ezvinhu. Muchiitiko chekuti bhenefiti yekuvhiya haina kuvimbiswa, dzimwe nzira dzekurapa dzinogona kusarudzwa.

Kurapa kushoma

Kurapa kushoma kweinodziya inzira yakasarudzika yekurapa kenza yechiropa, kusanganisira matatu anotevera:

1. Transcatheter arterial chemoembolization

Pinza chubhu kubva mutsinga dzechikadzi dzegumbo repasi kana iyo yereal radial yetsoka yepamusoro kuenda kuchiropa, uye vhara tsinga dzinodyisa bundu, uye bundu richaita ischemic necrosis. Panguva imwecheteyo, chemotherapeutic mishonga inoputirwa mukati mebundu ne lipiodol. Muchiitiko chekukanganisa yakatenderedza chiropa tishu, tumarara maseru anogona kuurayiwa zvakare.

2.Chemical ablation

Kazhinji pasi pekutungamira kweB ultrasound kana CT, jekiseni redoro rakazara munzvimbo yebundu rinoita kuti maseru emota akurumidze kupera mvura uye mapuroteni kudhinda uye kugwamba, zvichidaro kuuraya maseru emota, asi nzira iyi parizvino haishandisike.

3. Kubvisa muviri

Kusanganisira radiofrequency ablation uye microwave ablation, zvakare pasi pekutungamira kweB ultrasound kana CT, mamota maseru anourawa neiyo thermogenic mhedzisiro yetsono yekubaya.

Radiotherapy mukenza yechiropa

Radiotherapy inowanzo shandiswa seyekurapa kurapwa. Kune kenza yechiropa munzvimbo dzakasarudzika (senge intravascular, biliary turakiti, kana padyo nemitsinga mikuru), kurapwa kushoma kunokanganisa hakugone kuitika, kana kurapwa kushoma kunokanganisa hakugone kuitwa zvakachena. Radiotherapy inogona kusarudzwa.

Proton kurapa mukurapa kenza yechiropa

Radiotherapy kurapwa kunobatsira kune vazhinji varwere vane gomarara rechiropa mushure mekuvhiyiwa. Nekudaro, mune echinyakare radiotherapy, X-rays kana photon matanda zvinonzwisisika zvinopfuudzwa kune iyo nzvimbo yetumota uye zvakapoteredzwa zvinyama zvine hutano. Izvi zvinogona kukuvadza nyama dzepedyo dzine hutano uye zvinogona kukonzera zvakakomba mhedzisiro. Kurapa kweproton inogona kudzivirira zvakakwana izvi mhedzisiro.

Mukupesana, kurapwa kweproton kunoshandisa proton beam iradiation uye inogona kumira panzvimbo yebundu isina kusiya dosi re radiation mushure mebundu, saka ndiwe
zvichida kukuvadza nyama iri pedyo ine utano. Dzimwe nyanzvi dzinotenda kuti proton therapy yakachengeteka pane yechinyakare radiation therapy. Varwere vegomarara vane kusadzivirirwa kwakaderera, kuratidzwa kwemwaranzi kwakanyanya kunogona kukonzera kukuvadzwa kwemitezo yakajairwa, kukonzera kukanganisa kwakanyanya, uye kuunza mutoro wakakomba kumuviri wakatosimba. Kunyanya kenza yechiropa, maronda emamota ari pedyo nenhengo dzakawanda dzinokosha, dzakadai semapapu, mwoyo, gurokuro, nezvimwewo. Kunewo zvinowanzoitika muuropi metastases. Kusarudza proton kurapwa kunogona kunyatso kudzivirira kukuvadzwa kune akatenderedza matishu ane hutano uye kuwana bundu-kuuraya senge yechinyakare radiotherapy maitiro.

Kurapwa kwekenza yechiropa

1. Chemotherapy

Chemotherapy inosanganisira systemic chemotherapy uye yemunharaunda chemotherapy. Yemunharaunda chemotherapy ndiyo transcatheter arterial chemoembolization yataurwa pamusoro. Kubudirira kwe systemic chemotherapy kuri pasi pegumi muzana, uye mhedzisiro yacho yakakomba. Vazhinji varwere havasarudze.

Kurapa kwakanangidzirwa

Mishonga yakanangwa inotenderwa gomarara rechiropa kumba nekune dzimwe nyika

Sarudzo yemutsara wekutanga kurapwa kwecancer yechiropa

(1) Sorafenib

Tsvakurudzo dzinoverengeka dzekiriniki dzakaratidza kuti Sorafenib ine zvimwe zvikomborero zvekupona kune varwere vane kenza yepamusoro yechiropa munyika dzakasiyana-siyana uye mamiriro ezvinhu ane zvirwere zvakasiyana-siyana zvechiropa (chiyero cheuchapupu 1).

Iko kunowanzo kurudzirwa kushandiswa ndeye 400 mg nemuromo, kaviri pazuva. Inogona kushandiswa kuMwana-Pugh Kirasi A kana B varwere vane chiropa chinoshanda. Zvichienzaniswa neChidiki-Pugh B chiropa chinoshanda, Mwana-Pugh Kubatsirwa kwevarwere kuri pachena.

Inoda kutarisisa kune zvinokanganisa HBV uye chiropa mashandiro, uye kusimudzira manejimendi echiropa chechiropa chirwere panguva yese iyi. Mhedzisiro yakajairika ndeyemanyoka, kuonda, ruoko uye tsoka tsoka, mapundu, myocardial ischemia, uye neBP, izvo zvinowanzoitika mukati memavhiki maviri kusvika matanhatu mushure mekutanga kwekurapwa.

(2) Lemvatinib

Lenvatinib inokodzera varwere vasingachinjike vane danho IIb, IIIa, IIIb, chiropa chinoshanda Mwana-Pugh Kenza yechiropa, uye kurapwa kwaro kwekutanga hakusi kwakaderera kune sorafenib. Kenza yechiropa inoenderana neHBV ine zvirinani Kupona kwekubatsirwa [185] (huwandu hweuchapupu 1).

Lenvatinib yakagamuchirwa kuti ishandiswe muChild-Pugh A varwere vegomarara rechiropa vane gomarara repamusoro reropa. Kushandisa: 12mg, muromo, kamwe chete zuva nezuva kwehuremu hwemuviri ≥60kg; 8mg, muromo, kamwe chete zuva nezuva kwehuremu hwemuviri <60kg. Zvinowanzoitika nenjodzi hypertension, manyoka, kushomeka kwekuda kudya, kuneta, ruoko-tsoka syndrome, proteinuria, kuda kurutsa, uye hypothyroidism.

(3) Yakagadziriswa chemotherapy

The FOLFOX4 (fluorouracil, calcium folinate, oxaliplatin) protocol is approved in China for the treatment of locally advanced and metastatic liver cancer that is not suitable for surgical resection or local treatment (level of evidence 1).

Akawanda echikamu chechipiri zvidzidzo zvakataura kuti systemic chemotherapy ne oxaliplatin yakasanganiswa ne sorafenib inogona kugadzirisa zvinangwa zvekupindura, kuwedzera kufambira mberi-kusununguka kwehupenyu uye kupona kwese, uye nekupa chengetedzo yakanaka (padanho reuchapupu 3).

Kune varwere vane yakanaka chiropa mashandiro uye chimiro chemuviri, iyi yekubatanidza kurapa inogona kutariswa, asi kiriniki randomized inodzorwa zvidzidzo zvichiri kudikanwa kuti vape hukuru-hwepamusoro humbowo-hwakavakirwa humbowo hwekurapa. Uye zvakare, arsenic trioxide ine imwe palliative yekurapa maitiro pane yakakwira kenza yechiropa (chikamu cheuchapupu 3). Mukushandisa kwemakiriniki, kutarisirwa kunofanirwa kutorwa kuongorora uye kudzivirira huturu hwechiropa neitsvo.

Yechipiri-mutsara kurapa kenza yechiropa

(1) Regorafenib

Regorafenib inogamuchirwa kuti ishandiswe mune varwere vane nhanho IIb, IIIa, uye IIIb CNLC gomarara rechiropa avo vakamborapwa ne sorafenib (humbowo nhanho 1). Iko kushandiswa i160mg kamwe zuva nezuva kwemavhiki matatu uye kumiswa kwe3 vhiki.

MuChina, iyo yekutanga dosi inogona kuve 80mg kana 120mg kamwe, kamwe pazuva, uye zvishoma nezvishoma ichiwedzera zvinoenderana nekushivirira kwemurwere. Zviitiko zvakajairika zvinowedzerwa neBP, ruoko-tsoka tsoka ganda, kuneta, uye manyoka.

(2) Navumab uye Paimumab

IU.S. FDA yakabvumira kushandiswa kweNavulinu monoclonal antibodies (Nivolumab) uye Pabrolizumab monoclonal antibodies (Pembrolizumab) kune varwere vane kenza yechiropa vakafambira mberi kana vasingakwanisi kushivirira sorafenib mushure mekurapa kwesorafenib yapfuura (chiyero cheuchapupu 2).

Parizvino, immunological checkpoint inhibitors zvakazvimiririra zvakagadzirwa nemakambani eChina, akadai seCarellidizum monoclonal antibodies, Treplepril monoclonal antibodies, uye Xindili monoclonal antibodies, ari kuongorora kiriniki. Iko kusanganiswa kweiyo immunotherapy uye yakanangwa zvinodhaka, chemotherapeutic mishonga, uye topical kurapa kuri kugara kuchiongororwa.

Mamwe ma immunomodulators (akadai se interferon α, thymosin α1, nezvimwewo), cellular immunotherapy (yakadai se chimeric antigen receptor T cell therapy, CAR-T, and cytokine-induced killer cell therapy, CIK) all have certain antitumor effects. However, it is yet to be verified by large-scale clinical studies.

(3) Yechipiri-mutsetse nzira dzekurapa dzinowanikwa muUnited States

Uye zvakare, iyo US FDA inobvumidza cabozantinib yevarwere vane gomarara rechiropa iro rakafambira mberi mushure mekutanga-line system kurapa (humbowo mwero 1), uye inobvumidza kushandiswa kweLemorex monoclonal antibody yechipiri-mutsara kurapwa kwevarwere vane chiropa AFP mazinga ≥400ng / mL (humbowo chikamu 1)). Zvisinei, mishonga iyi miviri haina kutengeswa kuChina. Iyo kiriniki yekutsvagisa epamba diki-mamorekuru anti-angiogenesis inotarisa zvinodhaka apatinib yechipiri-mutsara kurapwa kwevarwere vegomarara rechiropa iri kuenderera.