medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-17-17-21medalphabet-3264Research ArticleСтатьиРоль мультидисциплинарной команды в лечении неоперабельного ГЦР: какие возможности существуют сегодняRole of multidisciplinary team in management of unresectable HCC: Opportunities that exist todayhttps://orcid.org/0000-0001-8295-2715ШвейкинА. О.ShveykinA. O.

Швейкин Александр Олегович, к. м. н., зав. 5-м хирургическим отделением общей онкологии

Московская область, г. о. Красногорск, пос. Истра

Shveykin Aleksandr O., PhD Med, head of 5th Surgical Dept of General Oncology

Moscow Region, Istra

alex5577@yandex.ruhttps://orcid.org/0000-0002-9243-6068КаннерД. Ю.KannerD. Yu.

Каннер Дмитрий Юрьевич, к. м.н, гл. врач

Московская область, г. о. Красногорск, пос. Истра

Kanner Dmitry Yu., PhD Med, chief physician

Moscow Region, Istra

kannerdy@zdrav.mos.ruГАУЗ «Московская городская онкологическая больница № 62 Департамента здравоохранения Москвы»РоссияMoscow City Oncological Hospital № 62Russian Federation202322102023017Диагностика и онкотерапия (2)1721Copyright © Швейкин А.О., Каннер Д.Ю., 20232023Швейкин А.О., Каннер Д.Ю.Shveykin A.O., Kanner D.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3264

Гепатоцеллюлярный рак (ГЦР) – одна из наиболее распространенных и в то же время малоизвестных в широкой клинической практике онкопатологий ЖКТ. ГЦР занимает пятое место в мире в структуре онкологической заболеваемости и третье – по онкологической смертности. Несмотря на усовершенствование методов диагностики, диагноз ГЦР устанавливается по-прежнему на поздних стадиях заболевания. Вследствие отсутствия скрининга среди пациентов с циррозом печени (группы риска ГЦР) смертность от гепатоцеллюлярного рака превосходит заболеваемость. Привлечение врачей различных специальностей считается наиболее эффективным подходом к лечению рака в современной динамичной и сложной системе здравоохранения. Одна из нозологий, где крайне важно внедрение и применение системы мультидисциплинарного консилиума, – гепатоцеллюлярный рак, так как в лечении этих пациентов принимает участие большое количество клиницистов различных специальностей. Эффективность междисциплинарного подхода у пациентов с ГЦК подтверждена клиническими исследованиями. Однако создание таких мультидисциплинарных консилиумов для пациентов с ГЦР имеет вполне объективные трудности: низкий процент курабельных пациентов на момент выявления данного заболевания и постановки диагноза либо за счет исходно диссеминированного опухолевого процесса, либо в связи с исходно низким функциональным статусом этих больных [2]. Преодоление этих препятствий и создание подобных команд, их широкое тиражирование и интеграция в клиническую практику позволят увеличить количество пациентов, выявляемых на более ранних стадиях, и закономерно улучшить ближайшие и отдаленные результаты лечения таких больных.

Hepatocellular cancer (HCC) is one of the most common and, at the same time, little-known gastrointestinal oncopathologies in wide clinical practice. HCC ranks 5th in the world in the structure of oncological morbidity and 3rd in cancer mortality. HCC accounts for 70–85 % of all primary liver tumors. The involvement of doctors from various specialties is considered the most effective approach to cancer treatment in today’s dynamic and complex healthcare system. One of the nosologies where the introduction and application of a multidisciplinary consultation system is extremely important is HCC, because a large number of clinicians of various specialties are involved in the treatment of these patients. The effectiveness of an interdisciplinary approach in patients with HCC has been confirmed by clinical studies. However, the creation of such multidisciplinary consultations for patients with HCC has quite objective difficulties: A low percentage of curable patients at the time of detection of this disease and diagnosis, either due to the initially disseminated tumor process, or due to the initially low functional status of these patients. Overcoming these obstacles and creating such teams, their wide replication and integration into clinical practice will increase the number of patients detected at earlier stages and naturally improve the immediate and long-term results of treatment of such patients

гепатоцеллюлярный ракмультидисциплинарный консилиуммультидисциплинарная командаhepatocellular cancermultidisciplinary councilmultidisciplinary teamДанная публикация подготовлена при финансовой поддержке компании «Эйсай». Авторы несут полную ответственность за содержание публикации и редакционные решения.This publication has been produced with the financial support of Eisai. The authors are solely responsible for the content of the publication and editorial decisions.ReferencesIARC GLOBOCAN 2020, OECD Health Statistics 2021.IARC GLOBOCAN 2020, OECD Health Statistics 2021.Diaz-Gonzalez A, Reig M, Bruix J. Treatment of Hepatocellular Carcinoma. Dig Dis 2016; 34: 597–602.Diaz-Gonzalez A, Reig M, Bruix J. Treatment of Hepatocellular Carcinoma. Dig Dis 2016; 34: 597–602.Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JSA. Successful strategies in implementing multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Mult Health. 2018; 11: 49–61.Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JSA. Successful strategies in implementing multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Mult Health. 2018; 11: 49–61.Cancer Research UK. Improving the effectiveness of multidisciplinary team meetings in cancer services. London: UK, Cancer Research UK; 2017.Cancer Research UK. Improving the effectiveness of multidisciplinary team meetings in cancer services. London: UK, Cancer Research UK; 2017.Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 2016; 150: 835–8.Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 2016; 150: 835–8.Osarogiaghon R, Freeman R, Krashna M. Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs. Transl Lung Cancer Res 2015; 4: 448–455.Osarogiaghon R, Freeman R, Krashna M. Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs. Transl Lung Cancer Res 2015; 4: 448–455.Freytag M, Herrlinger U, Hauser S, et al. Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome. BMC Cancer 2020; 20: 355.Freytag M, Herrlinger U, Hauser S, et al. Higher number of multidisciplinary tumor board meetings per case leads to improved clinical outcome. BMC Cancer 2020; 20: 355.Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ 2001; 323: 625–628.Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ 2001; 323: 625–628.National Breast and Ovarian Cancer Centre. 2008. Multidisciplinary cancer care in Australia: A national audit 2006, summary report.National Breast and Ovarian Cancer Centre. 2008. Multidisciplinary cancer care in Australia: A national audit 2006, summary report.Masch WR, Parikh ND, Licari TL. Radiologist quality assurance by nonradiologists at tumor board. J Am Coll Radiol 2018; 15: 1259–1265.Masch WR, Parikh ND, Licari TL. Radiologist quality assurance by nonradiologists at tumor board. J Am Coll Radiol 2018; 15: 1259–1265.Sinn DH, Choi GS, Park HC, et al. Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients.PLoS ONE 2019;14: e0210730.Sinn DH, Choi GS, Park HC, et al. Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients.PLoS ONE 2019;14: e0210730.Bunnell CA, Weingart SN, Swanson S, et al. Models of multidisciplinary cancer care: Physician and patient perceptions in a comprehensive cancer center. J Oncol Pract 2010; 6: 283–288.Bunnell CA, Weingart SN, Swanson S, et al. Models of multidisciplinary cancer care: Physician and patient perceptions in a comprehensive cancer center. J Oncol Pract 2010; 6: 283–288.Perz J. F., Armstrong G. L., Farrington L. A., Hutin Y. J., Bell B. P. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J. Hepatol. 2006; 45: 529–538. DOI: 10.1016/j.jhep.2006.05.013.Perz J. F., Armstrong G. L., Farrington L. A., Hutin Y. J., Bell B. P. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J. Hepatol. 2006; 45: 529–538. DOI: 10.1016/j.jhep.2006.05.013.Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71 (3): 209–249.Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71 (3): 209–249.Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362: 1907–1917.Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362: 1907–1917.EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69: 182–236.EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69: 182–236.LI-RADS version 2018, American college of Radiology.LI-RADS version 2018, American college of Radiology.Cho YK, Rhim H, Noh S. Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: A systematic review. J Gastroenterol Hepatol 2011; 26: 1354–1360.Cho YK, Rhim H, Noh S. Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: A systematic review. J Gastroenterol Hepatol 2011; 26: 1354–1360.Llovet JM, Ricci S, Mazzaferro V et al. Sorafenib in advanced hepato-cellular carcinoma. N Engl J Med 2008; 359: 378–90.Llovet JM, Ricci S, Mazzaferro V et al. Sorafenib in advanced hepato-cellular carcinoma. N Engl J Med 2008; 359: 378–90.Cheng AL, Kang YK, Chen Z et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: A phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10: 25–34.Cheng AL, Kang YK, Chen Z et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: A phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10: 25–34.Kudo M. Molecular targeted agents for hepatocellular carcinoma: Current status and future perspectives. Liver Cancer 2017; 6: 101–12.Kudo M. Molecular targeted agents for hepatocellular carcinoma: Current status and future perspectives. Liver Cancer 2017; 6: 101–12.Zhu AX, Rosmorduc O, Evans TR et al. SEARCH: A phase III, randomized, double-blind, placebo-controlled trial of sorafenib plus erlotinib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2015; 33: 559–66.Zhu AX, Rosmorduc O, Evans TR et al. SEARCH: A phase III, randomized, double-blind, placebo-controlled trial of sorafenib plus erlotinib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2015; 33: 559–66.Kudo M, Finn RS, Qin S et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomised phase 3 non-inferiority trial. Lancet 2018; 391 (10126): 1163–73.Kudo M, Finn RS, Qin S et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomised phase 3 non-inferiority trial. Lancet 2018; 391 (10126): 1163–73.U. S. Food and Drug Administration FDA Approves Lenvatinib for Unresectable Hepatocellular Carcinoma. Accessed on 3 January 2019. Available online: https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm617185.htmU. S. Food and Drug Administration FDA Approves Lenvatinib for Unresectable Hepatocellular Carcinoma. Accessed on 3 January 2019. Available online: https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm617185.htmA-L Cheng, S Qin, M Ikeda, P Galle, M Ducreux, A Zhu, T-Y Kim, M Kudo, V Breder, P Merle, A Kaseb, D Li, W Verret, Z Xu, S Hernandez, J Liu, C Huang, S Mulla, H Y Lim, R Finn, LBA3 IMbrave150: Efficacy and safety results from a ph III study evaluating atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (Sor) as first treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC), Annals of Oncology, Volume 30, Issue Supplement 9, November 2019.A-L Cheng, S Qin, M Ikeda, P Galle, M Ducreux, A Zhu, T-Y Kim, M Kudo, V Breder, P Merle, A Kaseb, D Li, W Verret, Z Xu, S Hernandez, J Liu, C Huang, S Mulla, H Y Lim, R Finn, LBA3 IMbrave150: Efficacy and safety results from a ph III study evaluating atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (Sor) as first treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC), Annals of Oncology, Volume 30, Issue Supplement 9, November 2019.Bruix J., Qin S., Merle P., Granito A., Huang Y. H., Bodoky G., Pracht M., Yokosuka O., Rosmorduc O., Breder V., et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017; 389: 56–66.Bruix J., Qin S., Merle P., Granito A., Huang Y. H., Bodoky G., Pracht M., Yokosuka O., Rosmorduc O., Breder V., et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017; 389: 56–66.Abou-Alfa G.K., Meyer T., Cheng A. L., El-Khoueiry A.B., Rimassa L., Ryoo B. Y., Cicin I., Merle P., Chen Y., Park J. W., et al. Cabozantinib in Patients with Advanced and Progressing Hepatocellular Carcinoma. N. Engl. J. Med. 2018.Abou-Alfa G.K., Meyer T., Cheng A. L., El-Khoueiry A.B., Rimassa L., Ryoo B. Y., Cicin I., Merle P., Chen Y., Park J. W., et al. Cabozantinib in Patients with Advanced and Progressing Hepatocellular Carcinoma. N. Engl. J. Med. 2018.El-Khoueiry A.B., Sangro B., Yau T., Crocenzi T. S., Kudo M., Hsu C., Kim T. Y., Choo S. P., Trojan J., Welling T. H.R., et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): An open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017.El-Khoueiry A.B., Sangro B., Yau T., Crocenzi T. S., Kudo M., Hsu C., Kim T. Y., Choo S. P., Trojan J., Welling T. H.R., et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): An open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017.Freeman R. B., Jr., Steffick D. E., Guidinger M. K., Farmer D. G., Berg C. L., Merion R. M. Liver and intestine transplantation in the United States, 1997–2006. Pt 2Am. J. Transpl. 2008; 8: 958–976.Freeman R. B., Jr., Steffick D. E., Guidinger M. K., Farmer D. G., Berg C. L., Merion R. M. Liver and intestine transplantation in the United States, 1997–2006. Pt 2Am. J. Transpl. 2008; 8: 958–976.Yao F. Y., Kerlan R. K., Hirose R., Davern T. J., Bass N. M., Feng S., Peters M., Terrault N., Freise C. E., Ascher N. L. Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis. Hepatology. 2008; 48: 819–827.Yao F. Y., Kerlan R. K., Hirose R., Davern T. J., Bass N. M., Feng S., Peters M., Terrault N., Freise C. E., Ascher N. L. Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis. Hepatology. 2008; 48: 819–827.

The authors declare that there are no conflicts of interest present.