Ungakuvimbela kanjani ukuphindeka komdlavuza wesibindi?

Ukuvimbela umdlavuza wesibindi

Ukuvimbela ukuphindeka komdlavuza wesibindi, ukuvimbela ukuphindeka komdlavuza wesibindi ngemuva kokuhlinzwa, ukuvimbela ukuphindeka komdlavuza wesibindi, ukuvimbela ukuphindeka komdlavuza wesibindi

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 isisu progression-free survival of about 3-7 months and a total survival of about 9-13 months

Izinga lokusinda leminyaka emihlanu lomdlavuza wesibindi

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

Iziguli ezingama-44% zitholwe zinomdlavuza wokuqala wesibindi futhi izinga lokusinda kwazo iminyaka engu-5 lalingama-31%.

Uma umdlavuza wesibindi usabalalele ezicutshini noma ezithweni ezizungezile kanye / noma kuma-lymph node wesifunda, isilinganiso seminyaka emihlanu yokusinda ngu-5%.

Uma umdlavuza usabalele kude nomzimba, izinga lokusinda leminyaka emi-5 lingu-2%.

Kodwa-ke, noma ngabe umdlavuza utholakala ukuthi usesigabeni esisezingeni eliphakeme, izindlela zokwelashwa ezahlukahlukene zingasetshenziswa ukusiza iziguli ezinomdlavuza wesibindi ukwelula isikhathi sokuphila kwazo. Ukuhlinzwa kuyindlela yokwelashwa engcono kakhulu yeziguli ezinomdlavuza wesibindi. Iningi leziguli licabanga ngokuhlinzwa okuhlinzekwayo kuqala, kepha zisabhekana nengozi yokuphindeka ngemuva kokuhlinzwa kabusha.

Ungakuvimbela kanjani ngempumelelo ukuphindeka komdlavuza wesibindi? 

Ukubuyekeza ngezikhathi ezithile

Compared with malignant tumors such as breast cancer and umphunga 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% .

Ngakho-ke, kuyadingeka ukuthi ubuyekeze njalo futhi ulandele i-oda likadokotela, noma ngabe kutholakala izimpawu zokuqala zemetastasis, kusekhona ithuba lokuvuselelwa ngokuhlinzwa. Uma kutholakala wonke ama-metastases womzimba ngenxa yokunganakwa kokubuyekezwa, ukwelashwa kuzoba nzima kakhulu.

Izinto ezidinga ukuhlolwa ukubuyekezwa komdlavuza wesibindi zihlanganisa:

Isivivinyo somsebenzi wesibindi

Ukuhlola ukusebenza kwesibindi ngokuvamile yikho okukwazi kakhulu ukubona isimo samanje sesibindi sezifo nokuvuvukala, kodwa ngokuvamile bayehluleka ukubona ukuba khona kwe-cirrhosis nomdlavuza wesibindi, futhi abakwazi ukubona ukuthi banamagciwane ahlukahlukene e-hepatitis.

I-Alpha fetoprotein

Uma i-preoperative alpha-fetoprotein positive incipha iye kokujwayelekile ngemuva kokukhishwa kokuhlinzwa komdlavuza wesibindi, bese inyuka futhi, ayikho incazelo yesifo esingalapheki sesibindi esisebenzayo, esibonisa ukuthi umdlavuza wesibindi ubuyile.

Ezigulini ezine-alpha-fetoprotein engeyinhle ngaphambi kokuphinde kutholakale umdlavuza wesibindi, i-alpha-fetoprotein ingaba ngehle ngesikhathi sokuphindeka, futhi i-alpha-fetoprotein kusamele ilandelwe ngemuva kokuhlinzwa.

I-ultrasound yesisu

I-B-ultrasound inezinzuzo zokuzwela, lula, nezindleko eziphansi. Kuyindlela ebalulekile yokuqapha ukuphindeka komdlavuza wesibindi. I-ultrasound yesisu ukuhlolwa okubalulekile

I-radiography yesifuba

Ezinye izilonda eziphindaphindiwe ziqala ukwenzeka emaphashini, ngakho-ke esifubeni X-ray ziyadingeka ukuze kuqashwe isifuba ukuphinda.

I-CT, i-PET-CT

Uma udokotela engakaqiniseki ukuthi uzodlulisela yini ngemva kwe-B-ultrasound, i-CT scan kufanele yenziwe ngesikhathi. Uma kukhona enye i-metastasis kwenye ingxenye, khona-ke ukuhlolwa kwe-PET-CT komzimba wonke kwenziwa. Iziguli ezinomdlavuza wesibindi ezinempilo zingaba nokuhlolwa kwe-PET-CT kanye ngonyaka ukuze kutholwe izimila ezinkulu kuno-2mm emzimbeni wonke ngesikhathi esisodwa, okunciphisa inkimbinkimbi nokungaqiniseki kokuhlolwa okuningi.

Shintsha indlela yokuphila

Yeka utshwala, yeka utshwala, yeka utshwala, izinto ezibalulekile zishiwo kathathu, kufanele uyeke utshwala. Futhi, ungabhemi, ungasebenzisi ngokweqile, futhi uhlale ujabule.

Ukuzivocavoca okufanele, izinyanga ezingu-2-3 ngemva kokuhlinzwa, ungenza izivivinyo ezithambile, njengokuhamba, futhi kancane kancane ukwandisa kusuka kumaminithi angu-15 kuya kumaminithi angu-40; ungakwazi futhi ukuzivocavoca i-qigong, i-Tai Chi, izivivinyo zomsakazo nezinye izivivinyo ezithambile.

Ukunakekelwa okukhethekile kufanele kukhokhelwe ekudleni, ungadli ukudla okubunjiwe, i-barbecue, i-bacon, i-tofu nokunye ukudla okuqukethe i-nitrite, futhi ungadli umuthi wendabuko nemikhiqizo yezempilo yase-China.

Ukudla kwangemva kokuhlinzwa kulula kakhulu, futhi ukutholakala kwamaprotheni asezingeni eliphakeme njengeqanda elimhlophe nenyama enciphile kuyanda ngokufanele. Ukudla okwenziwa ngemuva kokuhlinzwa kuvame ukusuka emanzini, iphalishi, ubisi, amaqanda ashubile, inhlanzi, inyama engenamafutha kuya ekudleni okujwayelekile.

Zama ukudla ukudla okugaya kalula, gwema okunamafutha, okubabayo, okucasulayo, okunzima, okunamathelayo nokunye ukudla, yidla ukudla okunomsoco, udle ukudla okumbalwa, futhi akufanele kugcwale.

Ungakuvimbela kanjani ukuphindeka komdlavuza wesibindi ngemuva kokuhlinzwa?

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 izindlela zokwelapha ezisebenzisayo, ngokuvamile hhayi njengohlelo lokwelashwa oluyinhloko.

Ukuhlinzwa kuhlanzekile

Indlela ekahle kakhulu yokwelapha umdlavuza wesibindi ukususa izilonda zesimila ukuze kuzuzwe umgomo wokwelapha ngokukhulu ukushesha. Uma izindlela zokuhlinzwa zifinyelelwa, zonke izimila zingasuswa ngokuhlinzwa.

Uma kunezilonda eziningi, indawo yokuhlasela inkulu kakhulu, noma ama-metastases akude, ukukhishwa kwesimila kungakhethwa ngokwesimo. Endabeni yokuthi inzuzo yokuhlinzwa ayiqinisekisiwe, ezinye izindlela zokwelashwa zingakhethwa.

Ukwelashwa okungajwayelekile

Ukwelashwa okuncane kuyindlela eyingqayizivele yokwelashwa komdlavuza wesibindi, kufaka phakathi ezintathu ezilandelayo:

1. I-transcatheter armoial chemoembolization

Faka ishubhu elisuka emthanjeni wobufazi womlenze ongezansi noma umthambo osabalalayo wesitho esingenhla uye esibindini, bese uvimba imithambo edlisa isimila, bese isimila sizobhekana necrosis yeschemic. Ngesikhathi esifanayo, izidakamizwa ze-chemotherapeutic zifakwe ku-tumor ne-lipiodol. Endabeni yokuthinta izicubu ezivamile zesibindi, amangqamuzana e-tumor angabulawa ngokuqhubekayo.

Ukukhishwa kwamakhemikhali

Imvamisa ngaphansi kokuqondiswa kwe-B ultrasound noma i-CT, umjovo wotshwala ophelele endaweni yesimila wenza ukuthi amangqamuzana e-tumor asheshe aphelelwe amanzi futhi amaprotheni akhombe futhi ahlangane, ngaleyo ndlela abulale amangqamuzana e-tumor, kepha le ndlela ayisetshenziswa kangako njengamanje.

3. Ukukhishwa komzimba

Kufaka phakathi i-radiofrequency ablation kanye ne-microwave ablation, futhi ngaphansi kokuqondiswa kwe-B ultrasound noma i-CT, amaseli wesimila abulawa ngumphumela we-thermogenic wenaliti yokubhoboza.

I-Radiotherapy kumdlavuza wesibindi

I-Radiotherapy ivame ukusetshenziswa njengokwelashwa okuhambisanayo. Ngomdlavuza wesibindi ezindaweni ezikhethekile (njenge-intravascular, tract biliary, noma imithambo emikhulu eseduze), ukwelashwa okuncane okuhlaselayo akukwazi ukufinyelelwa, noma ukwelashwa okuncane okungahlaseli kungenziwa ngokuhlanzekile. I-Radiotherapy ingakhethwa.

Ukwelashwa kwe-Proton ekwelashweni komdlavuza wesibindi

I-Radiotherapy iyindlela yokwelapha esiza iziguli eziningi ezinomdlavuza wesibindi ngemuva kokuhlinzwa. Kodwa-ke, ku-radiotherapy yendabuko, ama-X-ray noma imishayo ye-photon idluliselwa ngokungenakugwenywa endaweni yesimila nezicubu ezinempilo ezizungezile. Lokhu kungalimaza izicubu ezinempilo eziseduze futhi kungadala imiphumela emibi kakhulu. Ukwelashwa kwe-Proton ingagwema ngokuphelele le miphumela engemihle.

Ngokuphambene nalokho, ukwelashwa kwe-proton kusebenzisa i-proton beam irradiation futhi kungama endaweni yesimila ngaphandle kokushiya umthamo wemisebe ngemuva kwesimila, ngakho-ke nguwe
cishe ukulimaza izicubu eziseduze ezinempilo. Abanye ochwepheshe bakholelwa ukuthi ukwelashwa kwe-proton kuphephe kakhulu kunokwelashwa ngemisebe yendabuko. Iziguli ezinomdlavuza zinokuzivikela okuphansi, ukuchayeka emisebeni enamandla kakhulu kungabangela kalula ukulimala kwezitho ezivamile, kubangele ukusabela okubi kakhulu, futhi kulethe umthwalo omkhulu emzimbeni osuvele ubuthakathaka. Ikakhulukazi kumdlavuza wesibindi, izilonda zesimila ziseduze nezitho eziningi ezibalulekile, njengamaphaphu, inhliziyo, umphimbo, njll. Kukhona futhi ama-metastases obuchopho avamile. Ukukhetha ukwelashwa kwe-proton kungagwema ngempumelelo ukulimala kwezicubu ezizungezile ezinempilo futhi kufinyelele ukubulawa kwesimila njengomphumela wendabuko we-radiotherapy.

Ukwelashwa komdlavuza wesibindi

I-1. I-Chemotherapy

I-Chemotherapy ifaka i-systemic chemotherapy kanye ne-chemotherapy yendawo. Ukwelashwa ngamakhemikhali kwasendaweni yi-transcatheter arterial chemoembolization eshiwo ngenhla. Ukusebenza kwe-systemic chemotherapy kungaphansi kuka-10%, kanti imiphumela emibi ibucayi. Iziguli eziningi ngeke zikhethe.

Ukwelashwa okuhlosiwe

Izidakamizwa ezihlosiwe ezigunyazwe umdlavuza wesibindi ekhaya naphesheya

Ukukhethwa kokwelashwa komugqa wokuqala komdlavuza wesibindi

(1) uSorafenib

Ucwaningo oluningi lwezokwelapha lubonise ukuthi i-Sorafenib inezinzuzo ezithile zokusinda ezigulini ezinomdlavuza wesibindi othuthukile emazweni ahlukene nezizinda ezinezifo zesibindi ezahlukene (izinga lobufakazi 1).

Ukusetshenziswa okujwayelekile okunconyiwe kungu-400 mg ngomlomo, kabili ngosuku. Ingasetshenziselwa iziguli ze-Child-Pugh Class A noma B ezinokusebenza kwesibindi. Uma kuqhathaniswa nokusebenza kwesibindi se-Child-Pugh B, i-Child-Pugh Inzuzo yokusinda kweziguli isobala kakhulu.

Udinga ukunaka umthelela ku-HBV nokusebenza kwesibindi, futhi ukhuthaze ukuphathwa kwezifo eziyisisekelo zesibindi kuyo yonke inqubo. Izimpawu ezimbi kakhulu ezivame kakhulu uhudo, ukwehla kwesisindo, isifo sezandla nezinyawo, ukuqubuka, i-myocardial ischemia, nomfutho wegazi ophezulu, okuvame ukwenzeka phakathi kwamasonto amabili kuya kwayisithupha ngemuva kokuqala kokwelashwa.

(2) iLemvatinib

ILenvatinib ilungele iziguli ezingaphindaphindeki ezinesigaba IIb, IIIa, IIIb, ukusebenza kwesibindi Ingane-Pugh Umdlavuza wesibindi, kanti ukwelashwa kwayo kolayini wokuqala akuyona ngaphansi kwe-sorafenib. Umdlavuza wesibindi ohlobene ne-HBV unezinzuzo ezingcono zokusinda [185] (izinga lobufakazi 1).

ILenvatinib ivunyelwe ukusetshenziswa ezigulini ezinomdlavuza wesibindi i-Child-Pugh A ezinomdlavuza ophakeme wesibindi. Ukusetshenziswa: 12mg, ngomlomo, kanye ngosuku ngesisindo somzimba ≥60kg; I-8mg, yomlomo, kanye nsuku zonke isisindo somzimba <60kg. Ukusabela okuvamile okungajwayelekile kuyisifo somfutho wegazi ophezulu, isifo sohudo, ukuncipha kwesifiso sokudla, ukukhathala, isifo sezinyawo, i-proteinuria, isicanucanu ne-hypothyroidism.

(3) Ukwelashwa ngamakhemikhali okuhleliwe

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).

Izifundo eziningi zesigaba sesibili zibike ukuthi i-systemic chemotherapy ene-oxaliplatin ehlanganiswe ne-sorafenib ingathuthukisa amazinga okuphendula okwenziwe, inwebe ukusinda okungenazinqubekela phambili nokusinda okuphelele, futhi inikeze ukuphepha okuhle (izinga lobufakazi 3).

Ezigulini ezinokusebenza okuhle kwesibindi nesimo somzimba, le nhlanganisela yokwelashwa ingacatshangelwa, kepha izifundo ezilawulwa ngokungahleliwe zomtholampilo zisadingeka ukunikeza ubufakazi bezinga eliphezulu lobufakazi obususelwa ebufakazini. Ngaphezu kwalokho, i-arsenic trioxide inomphumela othile wokwelashwa okunciphisayo kumdlavuza wesibindi osezingeni eliphakeme (izinga lobufakazi 3). Ekusetshenzisweni komtholampilo, ukunakekelwa kufanele kuthathwe ukuqapha nokuvimbela ubuthi besibindi nezinso.

Ukwelashwa komugqa wesibili komdlavuza wesibindi

(1) I-Regorafenib

I-Regorafenib ivunyelwe ukusetshenziswa ezigulini ezinesifo somdlavuza wesibindi i-IIb, IIIa, no-IIIb CNLC abake baphathwa nge-sorafenib (level level 1). Ukusetshenziswa kungu-160mg kanye nsuku zonke amasonto ama-3 futhi kuyekisiwe iviki elingu-1.

E-China, umthamo wokuqala ungaba yi-80mg noma i-120mg kanye, kanye ngosuku, futhi ukhule kancane ngokuya ngokubekezelelana kwesiguli. Imicimbi emibi ejwayelekile ingumfutho wegazi ophezulu, ukusabela kwesikhumba sonyawo lwezandla, ukukhathala, nohudo.

(2) i-Navumab ne-Paimumab

I-US FDA igunyaze ukusetshenziswa kwe-Navulinu monoclonal antibodies (Nivolumab) kanye ne-Pabrolizumab monoclonal antibodies (Pembrolizumab) ezigulini ezinomdlavuza wesibindi eziye zathuthuka noma ezingakwazi ukubekezelela i-sorafenib ngemva kokwelashwa kwangaphambili kwe-sorafenib (izinga lobufakazi 2).

Njengamanje, izivikeli mzimba zokuhlolwa kokuzivikela ezakhiwe ngokuzimela yizinkampani zaseChina, ezinjenge-Carellidizum monoclonal antibodies, Treplepril monoclonal antibodies, kanye ne-Xindili monoclonal antibodies, ziyaqhubeka nokwenza ucwaningo. Ukuhlanganiswa kwe-immunotherapy nezidakamizwa ezihlosiwe, izidakamizwa ze-chemotherapeutic, kanye nokwelashwa kwezihloko nakho kuhlolwa njalo.

Amanye ama-immunomodulators (njenge-interferon α, i-thymosin α1, njll.), i-cellular immunotherapy (njenge i-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) Izinketho zokwelashwa komugqa wesibili ziyatholakala e-United States

Ngaphezu kwalokho, i-US FDA igunyaza i-cabozantinib yeziguli ezinomdlavuza wesibindi oseziqhubekele phambili ngemuva kokwelapha komugqa wokuqala (izinga lobufakazi 1), futhi ivuma ukusetshenziswa kwe-Lemorex monoclonal antibody ekwelashweni kolayini wesibili kweziguli ezinamazinga we-AFP wesibindi ≥400ng / mL (ubufakazi bezinga 1)). Kodwa-ke, le mithi emibili ayikathengiswa eChina. Ucwaningo lomtholampilo lwe-anti-angiogenesis elincane lasekhaya elihlose ukusebenzisa i-apatinib yokwelashwa komugqa wesibili kweziguli ezinomdlavuza wesibindi luyaqhubeka.