编者按：肝癌是一种起源于肝脏组织的恶性肿瘤，其中90%为肝细胞癌（HCC）。目前，全球肝癌发病率以每年3%的速率稳步上升。其中，尤以亚洲和中国的肝癌疾病负担最为严重，70%的肝癌新发病例来自亚洲，而50%来自中国。在主题为“肿瘤防治，赢在整合”的2023中国整合肿瘤学大会（CCHIO）上，《肿瘤瞭望》特别邀请到天津医科大学肿瘤医院宋天强教授与韩国延世大学医院放射肿瘤科Jinsil Seong教授，就中、韩两国肝癌诊治方面的特色进行介绍，以期整合不同国家的肝癌防治经验，更好改善HCC整体人群预后。

 

宋天强教授

天津医科大学肿瘤医院肝癌防治研究中心

 

Jinsil Seong教授

韩国延世大学医院放射肿瘤科

 

 

Oncology Frontier:How do both of you think of the current status of liver cancer diagnosis and treatment in East Asia?What are the unique characteristics of China and South Korea in the diagnosis and treatment of liver cancer?

 

Jinsil Seong教授：与中国一样，韩国肝癌的发病率也很高。幸运的是，我们有一个由政府覆盖的国家医疗保险系统，并且设定了2月2日肝癌日，目的是提高对肝癌筛查的认知。因为我们有很多乙肝患者，但如果定期进行超声检查和肿瘤标志物研究，可以发现早期癌症。我认为早期发现癌症非常重要。治疗是为了治愈，而不是缓解，这就是我想要关注的。接下来我想听听宋教授对中国的介绍。

 

First.Okay，like China，we Korean people have a high instance of liver cancer，and then we have a luckily a national healthcare insurance system covered by the government，and then we studied liver cancer day，the February 2nd to enhance awareness of liver cancer screening，because we have many hepatitis B virus patients，but if we have ultrasound exam and the Tumor Mark study regularly，we can detect early cancer，so I think that’s very important for detecting the cancer diagnosis in this early stage.Then treatment can be aimed for cure，not the palliation，so that’s what I want to focus on.And then I’d like to listen to Professor Song for China.

 

宋天强教授：在会上我就与Seong教授进行了交流，从她那里了解到在韩国有针对肝癌的全国范围内HCC筛查。但在中国目前尚缺乏这样的筛查，因此在中国大多数HCC患者在临床就诊时已处于中晚期，丧失了HCC根治性切除的时机，只有30%的HCC患者有机会进行根治性切除术。但近年来，靶向和免疫治疗发展迅速，给许多HCC患者提供了再次接受根治性切除术的机会。在中国，转化治疗非常流行，在这方面我们有很多方法和组合可以应用，我认为中国的转化治疗走在了世界很多国家前面。但我想未来，如果我们能像韩国那样在全国范围内进行HCC筛查，那么就可能在早期发现更多的患者，进而通过早期干预使患者获得更好的预后。

 

In the meeting，I consulted with Professor Song，and in Korea，there’s a nationwide HCC screening，but in China，there’s no similar screening for HCC.So most of patients in China for HCC，when they are diagnosed in the clinic，already in very advanced stage.So this is very different and therefore，in China only 30%of HCC patients have the chance to receive the radical resection and most of them already lost the chance.But in recent years，the target and the immunotherapy development vary fast.So give a lot of patients the opportunity to receive the radical resection again.So in China，the conversion therapy is very popular and we have a lot of methods and combinations.So maybe I think the conversion therapy in China and maybe better in a lot of countries in the world.But I think maybe in future in the future.If we could have a national wide screening for HCC such as Korea，so maybe more patients could be found in earlier stage，so maybe the prognosis is more better.

 

Jinsil Seong教授：我再补充一下，大多数肺癌患者的年龄是60或70岁，但大多数肝癌患者都是40或50岁左右。对于职场和家庭来说，这个年龄都是非常活跃的年纪。因此，如果这个年龄的患者，尤其是男性，罹患肝癌晚期，那么家庭就会出现一些问题，他的工作也会出问题。因此，我认为教育和治愈目标对肝癌患者非常重要。

 

Let me add one more thing.Well，in case of lung cancer，most patients are in the age of 60 or 70，but in liver cancer，most patients are in the 40，50 something.So that age is very active age for working place and also in every home.So if that age patient，particularly men，getting sick will be to advance liver cancer，then one family has some problem and his work plays a problem.So I think the education and aiming for cure is very，very important for liver cancer.Yeah.

 

 

Oncology Frontier:Professor Seong，the second question is about the topic of your presented at this congress.What’s your view on the Strategic Application of Radiotherapy for Hepatocellular Carcinoma in Immunooncology Era?

 

Jinsil Seong教授：实际上免疫治疗，特别是免疫联合抗VEGF治疗，现已经成为晚期HCC的标准治疗。然而，我们经常看到缓解率非常低，即使治疗费用非常高、非常昂贵。因此，我的建议是，我们需要尽一切努力来提高治疗效果。一种方法是减轻肿瘤负荷，另一种方法则是改变肿瘤的宏观环境，使其有利于免疫治疗。因此，我认为最近的治疗是实现这两个目标的非常好的工具。除了放疗外，放射性栓塞可能是另一个答案，但它非常昂贵。还有其他方法会起作用，但我仍然认为放疗比其他局部治疗更好。

 

Okay，actually immunotherapy，particularly combination immunotherapy plus NDBGF became a standard of care for advanced HCC right now.However，we frequently see very low response rate，even though the treatment cost very high，very expensive treatment.So what I suggest is that we need to try every efforts to enhance the therapeutic efficacy.One way is to reduce tumor burden and the other way is to change tumor macro environment to favor immunotherapy working.So I think the recent treatment is a very good tool to achieve both goals.Well，other than radiotherapy，then radio immunoregional embolization can be another answer，but it’s very expensive treatment.And also other tastes，well，it will be working，but still I think it’s gonna be radiotherapy really better than other local regional therapy.

 

 

Oncology Frontier:Professor Song，could you share the Tianjin experience of neoadjuvant therapy for liver cancer?

 

宋天强教授：肝癌的新辅助治疗是一个全新的领域，因为既往只有一些局部治疗被指南推荐，目前尚无相关指南推荐系统治疗作为新辅助治疗的常规临床实践。不过，我们已经注册了一系列的临床试验来做一些探索。和Seong教授一样，我们也发现了同样的现象：肿瘤负荷越低，免疫治疗越有效。因此，对于非常早期的肿瘤，单一免疫治疗也许更有效。对于处于中期阶段的肿瘤，就应该加上靶向治疗。通过将靶向联合免疫治疗与局部治疗（如经肝动脉化疗栓塞）进行比较，我们发现全身治疗优于局部治疗。所以我认为，在未来，对于非常早期阶段的HCC患者我们可以只使用单一的免疫疗法，对于中期HCC患者我们可以使用靶向联合免疫治疗作为新辅助治疗的手段。

 

And the new adjuvant therapy for liver cancer is totally in the new area because previously there’s only some local treatment was recommended by the guideline.But by now there is no voicing guideline recommended use systematic therapy as routine clinical practice for neoadjuvant therapy.But so we have registered a series of clinical trials to do some exploration.And we found the same phenomenon just like Professor Seong.And if the tumor likes tumor burden，and maybe the more effective of immunotherapy.So for the tumor viral，very early stage，perhaps mono-immunotherapy may be effective.If the tumor in the middle stage，maybe we should plus the target therapy.And if we compare with the target therapy and the plus the immunotherapy with the local treatment，such as high coattase，but we found the systemic therapy is better than the local treatment.So I think maybe future，we can，in very early stage HCC，just use the mono-immunotherapy.And for the middle stage HCC，we can use the target plus immunotherapy as the measure of neoadjuvant therapy.

 

Jinsil Seong教授：我很想问您关于中国的医疗设施情况，因为世界一流的医院都在东部沿海，在中国中部我不是很清楚，您可否评价一下中国医疗设施的分布和水平？

 

I’d love to ask you about medical facility situation in China，because all the world-level the good hospitals are in the east coast.And in the middle，in the inland China，I have no idea what’s going on.So could you make a comment on Chinese medical facility distribution and level?

 

宋天强教授：这是一个很好的问题。因为中国大多数重要城市和大城市都位于东部沿海地区，导致最优的医疗资源集中在这些地方。不过内地也有一些城市，比如成都、西安，他们也有很好的医院，例如成都的华西医院、西安的西京医院，这些医院，特别是放射治疗设备与上海、北京医院的一样好。但内地其他一些城市可能就不如这些城市了。

 

And this is a very good question，because most of the important city and big city located in the east coast，but in the inner，there are some cities such as Chengdu，such as Xi’an，they also have very good hospitals，such as Hwashi Hospital and the Xi Jing Hospital and in this hospital and the facility especially for radiology equipment is very good as the Shanghai Beijing but other city may be not as good as.

 

Jinsil Seong教授：因为每当我与在医院工作的中国专家交谈时，他们都会说，例如，我的医院一年的患者数量只是他们的十分之一，或者一个月的量。所以我的意思是，在中国有大量的患者去医院就诊，所以我认为你们需要更多的医院、更多的医生以及更好的医疗实践服务。

 

Because whenever I talk with the Chinese experts working in the hospital they say for example the number of patients that we gather in my hospital one year is only just in 10 or only one month in here so I mean huge number of patients visiting hospitals in China so I think you need more hospitals and more doctors for the patient you know the better on the medical practice service.more doctors for the patient you know the better on the medical practice service.

 

宋天强教授：是的，这是一个很好的建议。因为中国人口基数大、患者数量多，医院数量、医生数量和医疗资源有限，导致每个医生的就诊量远超国际同行。因此，改善医疗资源、增加医生数量势在必行，但基于现实而言，这是一个长期的过程，我们应该循序渐进地优化。

 

And yes that’s a very good advice because in China a lot of patients but the hospital is limited So we should and do the step by step.