Chemopreventive strategies in hepatocellular carcinoma.
Chemopreventive strategies in hepatocellular carcinoma.
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DOI：
10.1038/nrgastro.2013.143
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发表时间：
2014-01
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--
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肝细胞癌是导致癌症死亡的第三大常见原因。在大多数西方国家，由于感染慢性丙型肝炎的老年队列，肝癌的发病率和死亡率正在增加，预计由于肥胖流行，肝癌的发病率和死亡率将继续上升。需要采取化学预防策略，以降低或延缓肝细胞癌的发病。在已有疾病的患者中，普遍接种乙肝疫苗和抗病毒治疗一直与降低肝癌风险有关，特别是在获得持续病毒学应答的患者中。然而，抗病毒治疗用于肝癌初级预防的成本效益尚不清楚。几种常用的处方药似乎很有希望成为预防肝癌的化学预防药物，包括他汀类药物、抗糖尿病药物和阿司匹林。咖啡、维生素E、鱼油等饮食制剂以及植物化学物质也可能与降低患肝癌的风险有关。虽然理想情况下需要随机对照试验来确定疗效，但这样的化学预防试验在逻辑和伦理上都具有挑战性。精心设计的、前瞻性的、基于人群的队列研究可能为这些药物的化学预防效果提供最好的证据。
Hepatocellular carcinoma (HCC) is the third most common cause of death from cancer. The incidence and mortality of HCC are increasing in most Western countries as a result of an ageing cohort infected with chronic hepatitis C, and are expected to continue to rise as a consequence of the obesity epidemic. Chemopreventive strategies aimed at decreasing the risk or delaying the onset of HCC are needed. Universal immunization against HBV and antiviral therapy against HBV and HCV in patients with established disease has consistently been associated with reduced HCC risk, especially in patients who achieve sustained virologic response. However, the cost-effectiveness of antiviral therapy for primary HCC prevention is not known. Several commonly prescribed medications seem promising as chemopreventive agents against HCC, including statins, antidiabetic medications and aspirin. Dietary agents such as coffee, vitamin E and fish oil as well as phytochemicals might also be associated with reduced risk of HCC. Though randomized controlled trials are ideally needed to firmly establish efficacy, such chemoprevention trials are logistically and ethically challenging. Well-designed, prospective, population-based cohort studies might provide the best evidence for chemopreventive efficacy of these agents.
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