Epidemiology of Hepatocellular Carcinoma
Epidemiology of Hepatocellular Carcinoma
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DOI：
10.1007/978-3-319-34214-6_1
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
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作者：
White, Donna L.;Kanwal, Fasiha;El-Serag, Hashem B.
肝癌是癌症相关死亡率的第二大原因，全球每年有745，000人死亡。它主要表现为中年和老年人中出现的肝细胞癌（HCC）。它在很大程度上也是一种可预防的疾病。在全球范围内，大多数病例与慢性B型肝炎病毒（HBV）感染有关，发生在撒哈拉以南非洲和东亚（日本除外）。相比之下，丙型肝炎病毒（HCV）是北美和西欧的主要原因。最近在几个西方人群（特别是美国）中观察到HCC发病率的快速增加。与肥胖症和糖尿病发病率的快速增长基本平行。HCC风险的显著地理和种族差异也很明显，可能主要是由于已知的主要风险因素（如HBV和HCV感染）的患病率差异。其他确定的HCC危险因素包括年龄较大、男性、大量饮酒、黄曲霉毒素暴露、与血色病相关的铁过载以及可能的吸烟。饮食的作用在很大程度上是未知的;然而，在不同的病毒和非病毒疾病病因和人群中，高水平的含咖啡因的咖啡消费始终与降低HCC风险相关。宿主遗传的遗传变异也越来越多地与HCC风险相关，但在很大程度上缺乏确切的数据。总的来说，大多数HCC危险因素通过促进肝硬化的发展而起作用，肝硬化在大多数情况下是原发性前驱病变。一旦肝硬化建立，HCC的年风险范围在1%至7%之间，尤其是慢性HCV感染男性的进展风险增加。这篇综述从全球的角度详细讨论了肝癌的流行病学，特别是HCC。
Liver cancer is the second leading cause of cancer-related mortality resulting in 745,000 deaths annually worldwide. It is overwhelmingly manifest as hepatocellular carcinoma (HCC) arising in middle-aged and older adults. It is also largely a preventable disease. Globally, most cases are related to chronic hepatitis B virus (HBV) infection, and occur in sub-Saharan Africa and Eastern Asia (except Japan). In contrast, hepatitis C virus (HCV) is the leading cause in North America and Western Europe. Recent rapid increases in HCC rates have been observed in several Western populations (particularly in the U.S.) and largely parallel rapidly increasing rates of obesity and diabetes. Striking geographic and racial variations in HCC risk are also evident and likely predominantly due to known differences in the prevalence of major risk factors like HBV and HCV infections. Other established risk factors for HCC include older age, male sex, heavy alcohol intake, aflatoxin exposure, iron overload related to hemochromatosis, and possibly tobacco smoking. The role of diet is largely unknown; however, higher levels of caffeinated coffee consumption are consistently associated with decreased HCC risk across diverse viral and nonviral disease etiologies and populations. Host inherited genetic variation is also being increasingly examined in association with HCC risk, but definitive data are largely lacking. Overall, most HCC risk factors operate by promoting the development of cirrhosis which is primary precursor lesion in most cases. Once cirrhosis is established, the annual risk of HCC ranges between 1 and 7 % thereafter, with particularly increased risk of progression in males with chronic HCV infection. This review discusses in detail the epidemiology of liver cancer, and particularly of HCC, from a global perspective.