Editor’s Note: The 2023 Chinese Congress on Holistic Integrative Oncology (CCHIO), organized by the China Anti-Cancer Association and hosted by Tianjin Medical University Cancer Hospital, will take place in Tianjin from November 16th to 19th, 2023. This conference will continue to uphold the theme of “Cancer Control, Winning in Integration,” attracting anti-cancer experts and professionals from around the world to share cutting-edge academic achievements. Oncology Frontier had the privilege of interviewing Professor Min-Shan Chen, Director of Liver Surgery at the Sun Yat-sen University Cancer Center and Director of the Sun Yat-sen University Liver Cancer Institute, to discuss the current trends and treatment of liver cancer in China and to share his unique insights on the concept of “Cancer Control, Winning in Integration” and China’s unique approach to liver cancer transformation therapy.
Oncology Frontier: Can you please introduce the current trends and the state of diagnosis and treatment of liver cancer in China?
Prof. Min-Shan Chen: The situation of liver cancer prevention and treatment in China remains quite challenging. Liver cancer is currently the fourth most common malignant tumor and the second leading cause of cancer-related deaths in China, posing a serious threat to the lives and health of the Chinese population. China has approximately 400,000 new cases of liver cancer each year, accounting for about half of the global total. Liver cancer is characterized by a high incidence and high mortality rate, and most patients are diagnosed at an advanced stage, where patients are mostly ineligible for curative surgical treatment. Moreover, about 80% of liver cancer cases in China are caused by hepatitis B virus infection, and these patients often have varying degrees of hepatitis and cirrhosis, making treatment very challenging. Therefore, clinical practice should not be predominantly surgery-based but should instead develop into multidisciplinary treatments based on surgery. This is the current overall trend and treatment status of liver cancer in China.
Oncology Frontier: “Cancer Control, Winning in Integration” is the cancer prevention and control concept advocated by the China Anti-Cancer Association. How do you think this concept of integrated medicine can be applied in the diagnosis and treatment of liver cancer?
Prof. Min-Shan Chen: As proposed by Academician Dai-Ming Fan, Chairman of the China Anti-Cancer Association, “Cancer Control, Winning in Integration” means that the prevention and control of cancer should not rely on single methods or disciplines but should integrate advanced multidisciplinary concepts and clinical practices. “Cancer Control, Winning in Integration” requires healthcare professionals not to focus solely on “prevention” and “treatment” but to implement the integration concept in five aspects: “prevention,” “screening,” “diagnosis,” “treatment,” and “rehabilitation.” “Prevention” aims to reduce the incidence of cancer through preventive measures. “Screening” involves early detection of tumors through screening, leading to early “diagnosis” and “treatment.” After diagnosis and treatment, attention should also be paid to “recovery” or “health” to ensure patients’ well-being. Currently, clinical practice in cancer treatment in China should emphasize all five aspects, and we should pay attention to multi-stage a coordinated development, integrate multidisciplinary strengths for comprehensive treatment, and leverage the advantages of integrated medicine to maximize patient benefits.
Oncology Frontier: Liver cancer in China is mostly diagnosed at an advanced stage. In comprehensive liver cancer treatment, patients can undergo transformational surgery. Can you introduce China’s unique approach to liver cancer conversion chemotherapy?
Prof. Min-Shan Chen: As we mentioned earlier, about 80% of liver cancer patients in China are already at an advanced stage when diagnosed, and they have lost the opportunity for surgical resection. Early detection and immediate surgical treatment can provide patients with better treatment outcomes with less trauma and lower costs. If surgical treatment is not possible, patients may need multiple interventions and drug treatments, resulting in higher costs and often suboptimal outcomes. In fact, the five-year survival rate for such patients who have undergone multiple treatments can be close to zero.
Now, Chinese doctors have introduced the concept of “conversion chemotherapy,” which means creating potential opportunities for surgical resection through early-stage transformation therapy for initially inoperable liver cancer patients. By achieving surgical resection, patients’ outcomes have significantly improved. In this regard, there are many commonly used methods in China. Traditional intervention methods include transarterial chemoembolization, which, while effective in killing cancer, may not significantly reduce tumor size. In recent years, the Sun Yat-sen University Cancer Center has developed a new method of hepatic arterial infusion chemotherapy using the mFOLFOX regimen recommended in the national guidelines, rather than the cisplatin regimen used in countries such as Japan, South Korea, and Greece. Our research has shown that this method is highly effective in rapidly reducing tumor size, allowing previously inoperable tumors to become operable. In this area, our center has conducted multiple related studies, and we are currently promoting this method among our colleagues nationwide.
Additionally, we have explored drug treatments. In recent years, there have been significant developments in the field of drug therapy, and liver cancer drug treatment has entered the era of targeted immunotherapy. By combining drug treatments, patients’ outcomes have improved. Currently, we have various methods available, including hepatic arterial chemoembolization, targeted immunotherapy, and more. As a result, many late-stage liver cancer patients have gained the opportunity for surgical resection. To further standardize the clinical practice of conversion chemotherapy, experts in the field of liver cancer in China, led by Academician Jia Fan, have published the “Chinese Expert Consensus on Liver Cancer Transformation Therapy (2021 Edition),” and a second edition is underway. These unique approaches to liver cancer conversion chemotherapy in China represent the forefront of treatment, and I believe they are worth emulating by international peers.
Oncology Frontier: As the Chairman of the China Anti-Cancer Association’s Liver Cancer Professional Committee, what are your expectations for the development of liver cancer diagnosis, treatment, and research in China?
Prof. Min-Shan Chen: Firstly, I believe that early diagnosis and treatment are of paramount importance, as they are the key to improving the effectiveness of liver cancer treatment in China. As we mentioned earlier, the high cost, high frequency, and suboptimal outcomes of treatment for late-stage patients necessitate a focus on early diagnosis and treatment. Advanced laparoscopic techniques and local ablation methods are now widely used, and clinical experience is abundant. Early-stage liver cancer patients can achieve a 5-year, 10-year, or even 20-year survival period after standardized treatment. Therefore, we continually stress the importance of early diagnosis and treatment. However, public awareness in China is not yet sufficient, and many people are unwilling to undergo annual health check-ups. Hepatitis B carriers also find it challenging to maintain half-yearly check-ups. As clinical doctors, we repeatedly promote the importance of early diagnosis and treatment to the public through various channels such as books and newspapers. Elevating public awareness is a gradual process, and it requires relentless efforts from clinical doctors. Through the accumulation of experience, we aim to enhance the public’s health consciousness.
Secondly, I hope that the treatment of liver cancer can widely adopt a multidisciplinary collaborative approach. The treatment of liver cancer is not a matter of a single discipline but requires the integration of various methods such as surgery, transplantation, intervention, ablation, targeted drug therapy, radiotherapy, chemotherapy, and more. Clinical practice should establish multidisciplinary teams centered around liver cancer treatment. Taking the Sun Yat-sen University Cancer Center as an example, our surgeons are proficient in intervention, ablation, and drug therapy, mastering various methods for liver cancer treatment. This is achieved by establishing departmental structures focused on specific diseases. Our center’s treatment system has gradually gained recognition and acceptance in the field. Many hospitals have established similar closely cooperating multidisciplinary teams and have carried out a series of clinical studies to discover the best treatment methods for liver cancer. I believe that clinical doctors must explore new treatment methods through extensive clinical research. We should invest our efforts in clinical research because basic research is not necessarily the expertise of clinical doctors. We can collaborate with researchers in the field of basic medicine rather than devoting too much effort to applying for natural science funds.
