主席访谈丨Eduard Jonas教授：全球视角下的肝癌个体化治疗转变

Eduard Jonas教授： 非常感谢您的提问。我们目前主要遵循的仍是1999年首度颁布的指南，这些指南在全球范围内以多种版本被广泛采纳。其核心原则依然围绕肿瘤特征，即依据肝细胞癌（HCC）患者的肿瘤尺寸与数量来制定治疗方案。自那以后，我们在探索其他预后因素方面取得了显著进步，尤其是全组学研究领域的蓬勃发展，已经揭示了一系列生物学标志物，它们能为我们提供超越传统肿瘤大小与数量评估的更深层次信息。

然而，遗憾的是，这些先进的检测技术往往复杂繁琐，其复杂程度可能阻碍了它们被纳入现行指南的进程。因此，在临床实践层面，相较于多组学研究领域所取得的丰硕成果，真正能够应用于临床决策的相关数据仍显得相对匮乏。这一现状凸显了将前沿科研发现转化为临床实践应用的迫切需求与挑战。

Q1: At this conference, you delivered a report on the topic "Transitioning from guidelines to personalized medicine in the treatment of hepatocellular carcinoma - a global perspective" Could you share the key points of this presentation with our readers?

Prof. Eduard Jonas: Thank you very much for the question. So, we basically still apply the same guideline that was first published in 1999, in many forms present in national or regional hepatocellular carcinoma (HCC) management guidelines in the world. Those are still based on tumor characteristics, in other words, the size of the tumor and the number of the tumors in patients with HCC. Since then, there's been a lot of development in looking at other prognostic factors, which includes the whole spectrum of omics research, where they've even identified some markers that will tell us more, give us more information than just the size and the number of the tumors. Unfortunately, these tests are still very complex and probably too complex to include it in the guidelines. So, there's really a paucity of data in the clinical field related to the amount of research that has been done in the field of multi-omics.

Eduard Jonas教授： 的确，有迹象表明，在撒哈拉以南非洲地区，肝细胞癌主要由慢性乙型肝炎感染驱动，其独特之处在于，我们在非常年轻的患者群体中观察到大量病例，且这些肿瘤往往发现时已是晚期，除此之外，还频繁出现在未患肝硬化的个体中。这一现状无疑极具挑战性，对传统的诊断和治疗策略提出了严峻考验。

更为遗憾的是，即便在全球范围内有多个指南作为指导，但在许多国家，特别是资源有限的地区，这些指南中推荐的治疗手段往往难以获取。这不仅限制了医生的有效治疗选择，也给这类疾病的管理带来了极大的困难。因此，我们需要针对这些特定地区的疾病特征，探索更加适应本地实际情况的治疗策略，并努力提升医疗资源的可及性，以更好地应对这一挑战。

Q2: In your region of Africa, how do the guidelines for the diagnosis and treatments of hepatocellular carcinoma differ from those in other parts of the world, particularly in Western and Asian countries?

Prof. Eduard Jonas: The problem is that there are some indications that we are dealing with a different disease in Africa, especially in sub-Saharan Africa, where the disease is driven by chronic hepatitis B infection. We see a lot of tumors in very young people, with very advanced tumors, and also in patients without cirrhosis of the liver. And that is the problem. Unfortunately, even if we follow the guidelines, in many countries, the treatments that are advised in the current guidelines are not available, and that really presents a major challenge for managing this disease.