Primary prevention of hepatocellular carcinoma in developing countries
Primary prevention of hepatocellular carcinoma in developing countries
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DOI：
10.1016/s1383-5742(00)00027-2
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发表时间：
2000-04-01
影响因子：
5.3
通讯作者：
Hall, AJ
中科院分区：
文献类型：
--
作者：
Wild, CP;Hall, AJ
肝细胞癌是世界上第五大常见癌症，80%的病例发生在发展中国家。这种癌症几乎在所有病例中都是迅速致命的，通常从确诊之日起存活不到一年。这种癌症的主要危险因素已被确定为慢性乙肝(乙肝)和丙型肝炎(丙型肝炎)病毒感染以及饮食中接触黄曲霉毒素。有一种安全有效的疫苗可以预防慢性乙肝病毒感染。据估计，发展中国家大约70%的肝癌是由乙肝病毒引起的，那么接种疫苗每年可以在世界这些地区预防超过25万例病例。目前的一大挑战是确保在地方性感染国家获得疫苗。由于病毒的遗传异质性，开发针对丙型肝炎病毒的疫苗更具问题。然而，发展中国家24%的肝细胞癌可归因于丙型肝炎病毒(每年约93,000例)，疫苗将对癌症预防做出重大贡献。黄曲霉毒素污染饮食主食(花生、玉米)，是一种专利动物致癌物质，在人类中具有致癌作用，在伴随感染乙肝病毒的个人中具有特别高的风险。在社区一级，可在收获前或收获后通过限制对作物的真菌污染来减少接触；办法可能涉及低技术的收获后措施，以限制真菌生长，或对作物进行基因工程，以抵抗真菌感染或毒素生物合成。另一种措施是一旦摄入黄曲霉毒素，就使用化学预防药物如奥替拉兹来调节其新陈代谢。在地方性肝炎感染和食品受到真菌污染的国家，可用的资源往往非常有限。显然，接种乙肝疫苗是降低肝细胞癌发病率的首要任务。然而，目前全球有3.6亿慢性乙肝病毒携带者，乙肝疫苗仍未纳入许多国家的免疫接种计划。因此，采取措施减少由真菌引起的食品变质以及与黄曲霉毒素相关的饮食暴露也是一个可取的公共卫生目标。(C)2000 Elsevier Science B.V.保留所有权利。
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world with 80% of cases occurring in developing countries. The cancer is rapidly fatal in almost all cases with survival generally less than 1 year from diagnosis. The major risk factors for this cancer have been identified as chronic infection with hepatitis B (HBV) and hepatitis C (HCV) viruses and dietary exposure to aflatoxins. There is a safe and effective vaccine to prevent chronic HBV infection. Given estimates that approximately 70% of HCC in developing countries is attributable to HBV then vaccination could prevent more than 250,000 cases per year in these areas of the world. A major challenge now is to ensure the availability of vaccine in countries with endemic infection. Development of a vaccine against HCV is more problematic due to the genetic heterogeniety of the virus. However, with 24% of HCC in developing countries attributable to HCV (approximately 93,000 cases per year) a vaccine would make a major contribution to cancer prevention. Aflatoxins contaminate dietary staple foods (groundnuts, maize), are patent animal hepatocarcinogens and are carcinogenic in humans with particularly high risks in individuals with a concomitant infection with HBV. Reduction of exposure can be addressed at the community level either pre- or post-harvest by limiting fungal contamination of crops; approaches may involve low technology post-harvest measures to limit fungal growth or genetic engineering of crops to be resistant to fungal infection or toxin biosynthesis. An alternative measure is to modulate the metabolism of aflatoxins once ingested using chemopreventive agents e.g., oltipraz. The resources available in countries with endemic hepatitis infection and fungal contamination of foods are often severely Limited. Clearly HBV vaccination has to be the priority in the reducing the incidence of HCC. However, there are currently 360 million chronic HBV carriers worldwide and HBV vaccine is still not incorporated into many national immunisation programs. Thus measures to reduce food spoilage by fungi and the associated dietary exposure to aflatoxins is also a desirable public health goal. (C) 2000 Elsevier Science B.V. All rights reserved.