WelcomWelcom1原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展皖南醫(yī)學(xué)院弋磯山醫(yī)院吉兆寧原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展2流行病學(xué)近二十年來(lái),不管是在發(fā)達(dá)國(guó)家(如美國(guó))還是發(fā)展中國(guó)家或貧窮落后國(guó)家,原發(fā)性肝癌的發(fā)病率和病死率均呈上升趨勢(shì)。ThomasMB,etal.HepatocellularCarcinoma:T/NeedsforProgress.JClinOncol,2019,23:2892-9流行病學(xué)3肝癌常見(jiàn)四大相關(guān)因素炎病毒感染,尤其是乙型肝炎病毒。生活污水的不合理處置和飲用水的污染。你用水源一且被污染,可以進(jìn)一步加重伴有肝炎背景患者的病情,促進(jìn)肝癌形成飲用烈性酒和酗酒,往往加重了原有的肝臟疾病?！泓S曲霉毒素。肝癌常見(jiàn)四大相關(guān)因素4在我國(guó),盡管采取了“改水、防霉、防肝炎”等一系列預(yù)防措施,但多年來(lái)肝癌的發(fā)病率和病死率仍未見(jiàn)明顯回落。全球每年新增肝癌病例約63萬(wàn)例,其中55%發(fā)生在我國(guó)。ParkinDM,etal.Globalcancerstatistics,2019.CCancerclin.2019:55:74-108在我國(guó),盡管采取了“改水、防霉、防5中國(guó)為原發(fā)性肝癌高發(fā)地區(qū)2019年全球新發(fā)病例Sauth-CsstemAnla中國(guó)病例占55%,約344,000男性高發(fā)于女性(2.67AgestandardizedincidenceperGlobalCancerStatistics.2019.CACancerJC/in2019:55:74-108中國(guó)為原發(fā)性肝癌高發(fā)地區(qū)6原發(fā)性肝癌治療難點(diǎn)大多合并嚴(yán)重肝硬化易發(fā)生肝內(nèi)播散和遠(yuǎn)處轉(zhuǎn)移術(shù)后復(fù)發(fā)率高°約20%患者可獲手術(shù)治療原發(fā)性肝癌治療難點(diǎn)7肝痘規(guī)苑治療關(guān)鍵因素腫瘤大小和數(shù)目胂瘤累及部位和范圍靜脈癌栓與遠(yuǎn)處轉(zhuǎn)移肝功能代償程度及全身狀況肝痘規(guī)苑治療關(guān)鍵因素8原發(fā)性肝癌的治療模式原發(fā)性肝癌的治療模式9肝癌的治療模式及效果TreatmentOptionCommentsLivertransplantation5-yearsurvivalratesBefore2019:20%-36%Improvement2019-2019:61.1%0SurgicalresectionHistorical5-yearsurvivalrates30%o-40%0Recent5-vearPSwas480TACEImprovementin1-yearsurvivalfrom32%0(supportivecarecontrols)to57%oforTACEintientswithtumors<7cm,preservedliverfunctionandPsoThomasMB,etal.HepatocellularCarcinoma:TheNeeforProgress.ClinOncol,2019,23:2892-9肝癌的治療模式及效果10原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件11原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件12原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件13原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件14原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件15原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件16原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件17原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件18原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件19原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件20原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件21原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件22原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件23原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件24原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件25原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件26原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件27原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件28原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件29原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件30原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件31原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件32原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件33原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件34原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件35原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件36原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件37原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件38原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件39原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件40原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件41原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件42原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件43原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件44原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件45原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件46原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件47原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件48原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件49原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件50原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件51WelcomWelcom52原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展皖南醫(yī)學(xué)院弋磯山醫(yī)院吉兆寧原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展53流行病學(xué)近二十年來(lái),不管是在發(fā)達(dá)國(guó)家(如美國(guó))還是發(fā)展中國(guó)家或貧窮落后國(guó)家,原發(fā)性肝癌的發(fā)病率和病死率均呈上升趨勢(shì)。ThomasMB,etal.HepatocellularCarcinoma:T/NeedsforProgress.JClinOncol,2019,23:2892-9流行病學(xué)54肝癌常見(jiàn)四大相關(guān)因素炎病毒感染,尤其是乙型肝炎病毒。生活污水的不合理處置和飲用水的污染。你用水源一且被污染,可以進(jìn)一步加重伴有肝炎背景患者的病情,促進(jìn)肝癌形成飲用烈性酒和酗酒,往往加重了原有的肝臟疾病?！泓S曲霉毒素。肝癌常見(jiàn)四大相關(guān)因素55在我國(guó),盡管采取了“改水、防霉、防肝炎”等一系列預(yù)防措施,但多年來(lái)肝癌的發(fā)病率和病死率仍未見(jiàn)明顯回落。全球每年新增肝癌病例約63萬(wàn)例,其中55%發(fā)生在我國(guó)。ParkinDM,etal.Globalcancerstatistics,2019.CCancerclin.2019:55:74-108在我國(guó),盡管采取了“改水、防霉、防56中國(guó)為原發(fā)性肝癌高發(fā)地區(qū)2019年全球新發(fā)病例Sauth-CsstemAnla中國(guó)病例占55%,約344,000男性高發(fā)于女性(2.67AgestandardizedincidenceperGlobalCancerStatistics.2019.CACancerJC/in2019:55:74-108中國(guó)為原發(fā)性肝癌高發(fā)地區(qū)57原發(fā)性肝癌治療難點(diǎn)大多合并嚴(yán)重肝硬化易發(fā)生肝內(nèi)播散和遠(yuǎn)處轉(zhuǎn)移術(shù)后復(fù)發(fā)率高°約20%患者可獲手術(shù)治療原發(fā)性肝癌治療難點(diǎn)58肝痘規(guī)苑治療關(guān)鍵因素腫瘤大小和數(shù)目胂瘤累及部位和范圍靜脈癌栓與遠(yuǎn)處轉(zhuǎn)移肝功能代償程度及全身狀況肝痘規(guī)苑治療關(guān)鍵因素59原發(fā)性肝癌的治療模式原發(fā)性肝癌的治療模式60肝癌的治療模式及效果TreatmentOptionCommentsLivertransplantation5-yearsurvivalratesBefore2019:20%-36%Improvement2019-2019:61.1%0SurgicalresectionHistorical5-yearsurvivalrates30%o-40%0Recent5-vearPSwas480TACEImprovementin1-yearsurvivalfrom32%0(supportivecarecontrols)to57%oforTACEintientswithtumors<7cm,preservedliverfunctionandPsoThomasMB,etal.HepatocellularCarcinoma:TheNeeforProgress.ClinOncol,2019,23:2892-9肝癌的治療模式及效果61原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件62原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件63原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件64原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件65原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件66原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件67原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件68原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件69原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件70原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件71原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件72原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件73原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件74原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件75原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件76原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件77原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件78原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件79原發(fā)性肝癌的化療現(xiàn)狀及進(jìn)展課件80原發(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