与代谢功能障碍相关的脂肪性肝病和肝细胞癌:临床实践中的挑战
Radosław Osmański1, Maria Litwiniuk1,2, Marcin Mardas3
1Department of Oncology and Immuno-Oncology, Greater Poland Cancer Centre, Poznan, Poland.
肝细胞癌 (HCC) 在与代谢功能失调相关的脂肪性肝病 (MASLD),以前的非酒精性脂肪性肝病 (NAFLD) 患者中正在增加. 早期发现和治疗脂肪肝对于改善存活率至关重要.
科学领域:
- 肝病学
- 癌症学
- 代谢疾病
背景情况:
- 与慢性代谢性肝病相关的肝细胞癌 (HCC) 的发生率增加.
- 非酒精性脂肪肝 (NAFLD) 中的HCC可以发生在肝硬化和非肝硬化肝脏中,使诊断和监测复杂化.
- 目前的HCC治疗指南缺乏病因特定的策略,特别是与代谢功能障碍相关的脂肪性肝病 (MASLD).
研究的目的:
- 突出HCC在代谢性肝病中所带来的诊断和治疗挑战.
- 强调需要在HCC管理中采用病因特异性的方法.
- 强调早期发现和治疗脂肪肝及其危险因素的重要性.
主要方法:
- 在代谢性肝病中对HCC的当前文献的审查.
- 对现有的HCC监测和治疗指南中的局限性进行分析.
- 讨论免疫治疗在MASLD相关的HCC中的作用.
主要成果:
- 在NAFLD/MASLD中存在独特的监测挑战,因为它发生在非肝硬化肝脏中.
- 对于与MASLD相关的HCC免疫疗法的有效性存在有限的数据,通常依赖于子组分析.
- 目前的指导方针没有充分解决HCC的病因因素.
结论:
- 有效管理需要综合策略,包括脂肪肝的非药物和药物干预措施.
- 应对并发症和修改心脏代谢风险因素至关重要.
- 在高危人群中实施强有力的HCC早期检测计划对于生存至关重要.
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