Epidemiology of hepatocellular carcinoma in USA
Epidemiology of hepatocellular carcinoma in USA
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DOI：
10.1111/j.1872-034x.2007.00168.x
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发表时间：
2007-09-01
影响因子：
4.2
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
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作者：
El-Serag, Hashem B.
肝细胞癌（HCC）在美国的发病率正在上升。在过去二十年中，年龄调整后的发病率、住院率和死亡率翻了一番。HCC的发病率在年龄、性别、种族、地理区域等方面存在显著差异。虽然它仍然是老年人（平均年龄65岁）的痛苦，但已经有相当大的转变向年轻人的病例。1945年以后出生的人有出生队列效应。男性患此病的频率是女性的三倍，亚洲人是非裔美国人和西班牙人的两倍，而非裔美国人和西班牙人患此病的频率是高加索人的两倍。然而，最近的增长不成比例地影响了45至65岁的白人（和西班牙裔）男性。2-4年前获得的丙型肝炎病毒（HCV）感染解释了至少一半观察到的HCC增加；hcv相关的HCC在未来十年可能会继续增加。有很大比例的病例（15-50%）没有证据表明存在病毒性肝炎或重度饮酒的危险因素。在美国，表现为肥胖和糖尿病的胰岛素抵抗综合征正在成为HCC的一个危险因素，并可能通过非酒精性脂肪性肝病（NAFLD）的形成起作用；然而，其对当前HCC趋势的影响尚不清楚。虽然最近生存率有小幅改善，但总体上仍然很差（中位8个月）。美国基于人群的数据表明，HCC潜在治愈疗法的应用率较低，且存在显著的地区差异。
Hepatocellular carcinoma (HCC) is increasing in frequency the USA. Age-adjusted incidence, hospitalization, and mortality rates have doubled over the past two decades. There are striking differences in the incidence of HCC related to age, gender, race, and geographic region. Although it remains an affliction of the elderly (mean age 65), there has been a considerable shift toward younger cases. There is a birth cohort effect with those born after 1945. Men are affected three times more frequently than women, Asians two times more than African American and Hispanic people, who are affected two times more often than Caucasians. However, the recent increase has disproportionately affected Caucasian (and Hispanic) men between ages 45 and 65. Hepatitis C virus (HCV) infection acquired 2-4 decades ago explains at least half of the observed increase in HCC; HCV-related HCC is likely to continue to increase for the next decade. A variable but significant proportion of cases (15-50%) do not have evidence for the risk factors of either viral hepatitis or heavy alcohol consumption. Insulin resistance syndrome manifesting as obesity and diabetes is emerging as a risk factor for HCC in the USA and may operate through the formation of non-alcoholic fatty liver disease (NAFLD); however, its effect on the current trend in HCC remains unclear. While there has been a small recent improvement in survival, it remains generally dismal (median 8 months). Population-based data in the USA indicate low application rate of HCC potentially curative therapy and marked regional differences.