№80. Hepatocellular carcinoma
Modern strategies of staging and treatment of hepatocellular carcinoma in cirrhosisV.Y. KosyrevDOI 10.31917/2003169
This review presents the evolution of HCC staging systems as the acquisition of new data about the features of its carcinogenesis. The main staging systems are considered: Tumor-Node-Metastasis (TNM), Okuda, Barcelona Clinic Liver Cancer system (BCLC), Cancer of the Liver Italian Program (CLIP), Hong Kong Liver Cancer (HKLC) and others, in terms of their predictive significance. The author comes to the conclusion that the variety of classifications of the HCC indicates a certain dissatisfaction of all interested specialists in existing systems. At the same time, the BCLC classification, being somewhat conservative, despite the 20-year history of its application, currently remains one of the most convenient tools in determining the optimal therapeutic tactics and prognosis of patients with HCC.
Keywords: hepatocellular cancer; staging systems TNM, BCLC, HKLC.
Etiology, screening and early diagnosis of hepatocellular carcinoma: successes and new challenges related to the epidemic of obesityP.V. Balakhnin, A.S. Shmelev, E.G. Shachinov, V.I. MalkevichDOI 10.31917/2003179
Hepatocellular carcinoma (HCC) is a global public health problem, with morbidity and mortality continuing to increase.
The extremely high mortality rate (mortality/ morbidity – 0,95) is explained by the asymptomatic course of HCC at the
curable stages and the complete resistance of the tumor to chemoradiotherapy. Organization of effective surveillance and
screening – is the only possible way for improving the results of treatment of HCC in the foreseeable future. It is known
that HCC is almost always develops in the long-existing chronic liver disease, the etiologic factors of these diseases are
well known – it is viral hepatitis, alcohol and non-alcoholic fatty liver disease (NAFLD). In this regard, regular screening
in high-risk groups (all patients with cirrhosis and some patients with hepatitis B without cirrhosis) makes it possible to
detect HCC with a diameter of 1–2 cm, that is, at a very early stage of the disease. Timely treatment in this group of patients
allows achieving five-year survival at the level of 80–90%. In recent years, significant successes have been achieved in the
primary and secondary prevention of virus-associated HCC. The expected decrease in the incidence of this type of tumor
and an increase in the incidence of liver cancer caused by NAFLD may require a review of existing screening programs and
early diagnosis of HCC, as well as significantly increase their cost.
Keywords: hepatocellular carcinoma, cirrhosis, viral hepatitis, screening, non-alcoholic fatty liver disease, non-alcoholic steatohepatosis, non-alcoholic steatohepatitis, obesity.
The role of interventional radiology in the treatment of hepatocellular carcinomaB.I. Dolgushin, V.Y. KosyrevDOI 10.31917/2003203
The lecture highlights the growing role of various methods of interventional radiology in the treatment of very early
(BCLC 0), early (BCLC A) and intermediate (BCLC B) hepatocellular carcinoma against cirrhosis. The possibilities of using
various technologies of local therapy in the form of percutaneous chemical ablation and percutaneous energy ablation in
the treatment of hepatocellular cancer BCLC 0 and BCLC A. Separately, will highlight the latest technologies transarterial
chemoembolization, is widely used for the treatment of hepatocellular carcinoma BCLC stage B. Particular attention will
be paid to the use of percutaneous ablation and transarterial chemoembolization in the combined treatment of various
(BCLC 0 – BCLC C) stages of the disease.
Keywords: hepatocellular carcinoma, transarterial chemoembolization (TACE), radiofrequency ablation/ ablation (RFA).
Surgical treatment of hepatocellular cancerJ. Chinburen, D.T. ArybzhanovDOI 10.31917/2003212
Introduction: the principles of liver surgery have been described in the educational literature for many years, covering
the field of treatment for patients suffering from liver damage and stab wounds. However, formal liver resections became
more common only after the discovery of general anesthesia as a method of surgical anesthesia and antibiotics. The
first successful liver resection was performed by Dr. Langenbuch (C.J.A. Langenbuch) in 1888, although the patient was
reoperated due to bleeding. These complications did not stop surgeons from studying the structure of the liver, trying to
find effective methods for removing tumors. In 1897, Dr. Cantlie described the liver, which contributed to a deeper study
and analysis of the liver, and led to effective control of blood loss during surgery. One of the revolutionary contributions
to liver resection was made by Dr. Pringle, who in 1908 described the technique of compressing the incoming portal vein
vessels to reduce bleeding. Over the past 60 years, technological advances have led to the rapid development of various
methods of liver resection.
Liver resection is a complex surgical procedure because of the risk of extensive bleeding during dissection of the liver
and the complex anatomy of the biliary tract and blood vessels of the liver.
The method of issuing glisson knives in an extended hepatectomy: Bismuth previously described the two main
methods for performing right-sided hepatectomy. One of them is the so-called controlled hepatectomy method, and
the other describes the isolation of the glisson leg of the right lobe of the liver after dissection. The guided hepatectomy
method was described by Lort–Jacob (Lortat–Jacob); however, Foster and Berman, in his book Solid Liver Tumors,
mentions that in 1949 Honjo (Japan) performed an anatomical right-sided hepatectomy, which included the separation
of the right hepatic artery, right portal vein and right hepatic duct in the area of the gate of the liver. Bismuth combined
these two methods into one hepatectomy procedure. In 1984, Takasaki et al. (Takasaki et al.) first reported anterior
access to an extensive tumor located in the right lobe of the liver. He indicated that the bringing vessels were bandaged
and divided. Liver dissection should be performed before mobilization of the right lobe of the liver in order to avoid
manipulations when removing the tumor. This procedure is a safe and effective method of treating an extensive tumor
in the right lobe of the liver compared to the traditional approach. Surgeons should be able to apply this technique
when conducting a right-sided hepatectomy.
Conclusion: over the past 2 years, postoperative mortality after liver resection has decreased from 5,4% to 3% (including
patients with cirrhosis), due to increased attention to patient safety. However, the place for positive dynamics in this area
still remains. Due to the complexity of liver operations, this approach should be carried out in specialized institutions that
not only conduct such operations on an ongoing basis, but also teach the principles of minimally invasive surgery. In our
era, when priority is given to reducing costs in the field of medicine, comparing the costs and results of various methods
of liver resection plays an important role in the treatment of such patients.
Keywords: liver, extended hepatectomy, tumor, liver resection, surgery, hepatocellular cancer.
Systemic treatment of hepatocellular carcinoma: practical issues and perspectivesV.V. Breder, K.K. LaktionovDOI 10.31917/2003232
There is a growing list of medications for hepatocellular carcinoma. During the last two years several clinical trials confirmed survival benefit of multi-kinase angiogenesis inhibitors. As a result of pioneering trials an immune checkpoint inhibitors presented immunotherapy as promising liver cancer treatment option with real opportunity for long-lasting objective responses. This review provides current situation in the field of new therapies of HCC from the point of common medical
practice in searching for optimal first and second line treatment decision in different clinical situations and express an opinion on HCC immunotherapy development.
Keywords: hepatocellular carcinoma, multi-kinase inhibitors, checkpoint inhibitors.
Affordability of aprepitant for cancer patients in routine clinical practice in russia: analysis of government-established databaseA.A. Rumyantsev, A. S. Tyulyandina, M.Y. Fedyanin, A.A. Tryakin, I.A. Pokatayev, N.A. Rumyantsev, S.A. TyulyandinDOI 10.31917/2003243
Introduction: aprepitant-based prophylaxis for chemotherapy-induced nausea and vomiting (CINV) is an established
standard of care for cancer patients receiving high-emetogenic chemotherapy (HEC). However, no studies addressed the
issues of affordability of aprepitant in Russia and other low-resources countries.
Material and methods: for the purposes of this trial we collected data from government-establish electronic database
which use is mandatory for every government-funded healthcare organization. We conducted the analysis of this database for
electronic public procurement auctions of aprepitant and fosaprepitant, as well as cisplatin for the period from 01.01.2015 to
01.01.2018. The latter was chosen as a rough estimate of the number of patients receiving highly emetogenic therapy in Russia.
Results: we identified 278 electronic auctions for the purchase of aprepitant/ fosaprepitant. During the study period
77 045 packages of these drugs were purchased. For the same period 32474890 mg of cisplatin was purchased. This amount
of cisplatin is equivalent to 240 555 courses of HEC with an average dose of 75 mg/m2 per course and an average body surface
area of 1,8 m2. The estimated rate of affordability of aprepitant drugs for cancer was only 32%. Significant interregional
variability was revealed.
Conclusions: the vast majority of cancer patients in Russia do not have access to modern antiemetogenic therapy. The
development of effective and more affordable methods for the prevention of CINV remains an unmet need.
Keywords: aprepitant, Russia, healthcare, drugs affordability.
Modern possibilities of cytological diagnosis of pancreatic tumorsA.A. Mihetko, O.V. Ivko, S.V. Petrik, O.B. Tkachenko, M.V. Grinkevich, A.N. Sidorova, J.V. Petrik, E.S. Shalina, A.A. MihetkoDOI 10.31917/2003253
Objectives of the study. Efficiency assessment of cytological methods in the diagnosis of pancreatic tumors.
Material and methods. Our study includes results of 152 pancreatic fine needle aspirations of solid and cystic tumors,from 149 patients of the N.N. Petrov Cancer Research Center for the 3-year period (2016–2018).
Results. Representative cell material for morphological studies was obtained in 97,4% of cases. The results of cytological
examination of 111 patients with pancreatic tumors were compared with histological data. Malignant process was correctly
established in 93 out of 97 patients, benign process – in 13 out of 14 cases. The effectiveness of cytological examination
was 96,1%, sensitivity – 95,6%, specificity – 100%.
Conclusion. Pancreatic fine-needle aspiration cytology is safe, rapid, accurate and cost-beneficial modality of
investigation of pancreatic mass lesion.
Keywords: pancreas, fine-needle aspiration cytology, cytological diagnosis, cytohistological correlation.