Hepatocarcinoma. Epidemiología y diagnóstico con enfoque molecular
Hepatocarcinoma. Epidemiology and diagnosis with a molecular approach
Resumen
Uno de los mayores desafíos que enfrentan los investigadores en el área de la Hepatología, es el reconocimiento de factores de riesgo y predictores del desarrollo del hepatocarcinoma, para así poder trabajar en su prevención. En la actualidad la evidencia se centra en el estudio de factores moleculares del tumor que permitan demostrar su capacidad de progresión, para utilizarlos como marcadores predictores y hasta para clasificarlos y así instaurar medidas terapéuticas en estadios precoces. El carcinoma hepatocelular (HCC) representa aproximadamente el 90% de todos los casos de Cáncer Primario del Hígado. Es la segunda causa principal de muerte relacionada con el cáncer a nivel mundial y tiene una incidencia de 850.000 nuevos casos por año. Los principales factores de riesgo para desarrollar HCC son bien conocidos e incluyen la infección por los virus de la hepatitis B y C, la Enfermedad Grasa del Hígado por Disfunción Metabólica como recientemente se denominó, la ingesta de alcohol y la ingestión del metabolito fúngico aflatoxina B1. Se han identificado mutaciones durante las investigaciones que se han realizado sobre la patogénesis molecular del HCC que aun las más prevalentes no constituyen objetivos farmacológicos. La clasificación molecular del HCC no se ha establecido aun y la Clasificación de BCLC -Barcelona Clínic Liver Cancer es el principal algoritmo para la estratificación de pacientes según pronóstico y asignación de tratamiento. Los programas de vigilancia permiten la detección de tumores en estadio temprano que son susceptibles de terapias curativas: resección, trasplante de hígado o ablación local. Para ello se investigan biomarcadores para la terapia según la estratificación, estrategias adaptadas al paciente dirigidas a mutaciones impulsoras y / o activación de cascadas de señalización.
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