Carcinoma hepatocelular
- J. Martínez 1
- J.L. Lledó 1
- M. Aicart-Ramos 1
- B. Mateos 1
- A. Albillos 1
- 1 Hospital Universitario Ramón y Cajal. Madrid
ISSN: 0304-5412
Año de publicación: 2016
Título del ejemplar: Enfermedades del aparato digestivo (XII) Enfermedades hepáticas. Complicaciones de la cirrosis hepática
Serie: 12
Número: 12
Páginas: 683-692
Tipo: Artículo
Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado
Resumen
Epidemiología El carcinoma hepatocelular (CHC) es uno de los tumores más importantes por su frecuencia y morbimortalidad asociada. Es la tercera causa de muerte por cáncer y se desarrolla fundamentalmente en pacientes con cirrosis hepática con grados avanzados de fibrosis. Etiología Las causas más frecuentes son el virus de la hepatitis C, virus de la hepatitis B y alcohol, aunque las aflatoxinas constituyen otra causa importante a nivel mundial, sobre todo en países en vías de desarrollo. Por contra, en países desarrollados, la enfermedad hepática grasa no alcohólica es una causa emergente de CHC. Diagnóstico La aplicación de programas de vigilancia con ecografía en poblaciones de riesgo permite detectar el CHC en estadio precoz. El diagnóstico se establece mediante técnicas de imagen como la tomografía computarizada y la resonancia magnética, o mediante estudio anatomopatológico. Tratamiento Basándose en variables clínicas y tumorales, los pacientes con CHC se clasifican en estadios que permiten orientar el tratamiento más apropiado en cada caso.
Referencias bibliográficas
- Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5-S16.
- Forner A, Ayuso C, Real MI, Sastre J, Robles R, Sangro B, et al. Diagnóstico y tratamiento del carcinoma hepatocelular. Med Clin. 2009;132:272-87.
- Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245-55.
- Yang HI, Sherman M, Su J, Chen PJ, Liaw YF, Iloeje UH, et al. Nomograms for risk of hepatocellular carcinoma in patients with chronic hepatitis B virus infection. J ClinOncol. 2010;28:2437-44.
- Llovet JM, Ducreux M. EASL-EORTC Clinical Practice Gui-delines: Management of hepatocellular carcinoma. J Hepatol. 2012;56:908-43.
- Bruix J, Sherman M. AASLD Practice Guideline. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020-2.
- Velázquez RF, Rodríguez M, Navascués CA, Linares A, Pérez R, Sotorríos NG, et al. Prospective analysis of risk factors for HCC in patients with liver cirrhosis. Hepatology. 2003;37:520-7.
- Degos F, Christidis C, Ganne-Carrie N, Farmachidi JP, Degott C, Guettier C, et al. Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death. Gut. 2000;47:131-6.
- Lok AS, Seeff LB, Morgan TR, di Bisceglie AM, Sterling RK, Curto TM, et al. Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology. 2009;136: 138-48.
- El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic li-ver disease and hepatocellular carcinoma. Gastroenterology. 2004;126:460-8.
- Cabrera R, Nelson R. Review article: the management of hepatocellular carcinoma. Aliment Pharmacol Ther. 2009;31:461-76.
- Sangiovanni A, Del Ninno E, Fasani P, De Fazio C, Ronchi G, Romeo R, et al. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology. 2004;126:1005-14.
- Bolondi L, Sofia S, Siringo S, Gaiani S, Casali A, Zironi G, et al. Survei-llance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut. 2001;48: 251-9.
- Kulik K, Chokechanachaisakul A. Evaluation and management of hepatocellular carcinoma. Clin Liver Dis. 2015;19:23-43.
- Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MA, et al. Meta-analysis: surveillance with ultrasound for earlystage HCC in patients with cirrhosis. Aliment Pharmacol Ther. 200930:37-47.
- Di Bisceglie AM, Sterling RK, Chung RT, Everhart JE, Dienstag JL, Bonko-vsky HL, et al. Serum alphafetoprotein levels in patients with advanced hepatitis C: results from the HALT-C Trial. J Hepatol. 2005;43:434-41.
- Santi V, Trevisani F, Gramenzi A, Grignaschi A, Mirici-Cappa F, Del Pog-gio P, et al. Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival. J Hepatol. 2010;53:291-7.
- Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, et al. Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: A randomized trial comparing 3- and 6-month periodicities. Hepato-logy. 2011;54:1987-97.
- Forner A, Vilana R, Ayuso C, Bianchi L, Solé M, Ayuso JR, et al. Diagno-sis of hepatic nodules 20mm or smaller in cirrhosis: Prospective validation of then on invasive diagnostic criteria for hepatocellular carcinoma. Hepatology. 2008;47:97-104.
- Vilana R, Forner A, Bianchi L, García-Criado A, Rimola J, de Lope CR, et al. Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast enhanced ultrasound. Hepatology. 2010;51:2020-9.
- McGlynn KA, Tarone RE, El-Serag HB. A comparison of trends in the inci-dence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in the United States. Cancer Epidemiol Biomarkers Prev. 2006;15:1198-203.
- Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of theBarcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421-30.
- Forner A, Reig ME, Rodríguez de Lope C, Bruix J. Current stra-tegy for staging and treatment: the BCLC update and future pros-pects. Semin Liver Dis. 2010;30:61-74.
- Cillo U, Vitale A, Grigoletto F, Farinati F, Brolese A, Zanus G, et al. Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol. 2006;44:723-31.
- Omata M, Tateishi R, Yoshida H, Shiina S. Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: Ethanol injection therapy and radiofrequency ablation. Gastroenterology. 2004;127:S159-66.
- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693-9.
- Llovet JM, Bruix J. Molecular targeted therapies in hepatocellular carcinoma. Hepatology. 2008;48:1312-27.
- Villanueva A, Llovet JM. Targeted therapies for hepatocellular carcinoma. Gastroenterology. 2011;140:1410-26.
- Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology. 2005;129:122-30.
- Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003;37:429-42.
- Camma C, Schepis F, Orlando A, Albanese M, Shahied L, Trevisani F, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology. 2002;224: 47-54.
- Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poom RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35:1164-71.
- Salem R, Lewandowski RJ, Kulik L, Wang E, Riaz A, Ryu RK, et al. Ra-dioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140:497-507.
- Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359: 378-90.
- Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomized, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25-34.