Role of antiviral treatment for HCC prevention
Role of antiviral treatment for HCC prevention
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DOI：
10.1016/j.bpg.2014.07.017
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发表时间：
2014-10-01
影响因子：
3.2
通讯作者：
Iavarone, Massimo
中科院分区：
文献类型：
--
作者：
Colombo, Massimo;Iavarone, Massimo
肝细胞癌（HCC）的化学预防被列为慢性病毒性肝炎患者成功治疗的长期益处，但仍存在高度争议。在B型肝炎病毒（HBV）竞技场中，由于最初设计用于评估干扰素治疗抗病毒活性的研究中存在许多混淆，因此对干扰素和核苷（酸）类似物（NIX）研究的回顾性审查未能为HCC化学预防提供有力证据。然而，根据HCC的危险因素对患者进行分层后的结果进行再分析，仅为发现NUC治疗与非肝癌患者肝癌风险降低之间的关联提供了线索。在丙型肝炎病例中，对30项干扰素治疗患者的观察性研究进行的荟萃分析表明，与基础肝纤维化的严重程度无关，HCC发生风险降低70%以上，这在老年患者和更晚期肝纤维化患者中不太明显。尽管病毒学应答者HCC剩余风险的原因在很大程度上仍无法解释，但国际社会建议对抗病毒治疗的HBV和HCV应答者进行HCC监测。(C)2014爱思唯尔有限公司版权所有。
Chemoprevention of hepatocellular carcinoma (HCC) is listed as a yet highly debated long-term benefit of a successful treatment of patients with chronic viral hepatitis. In the hepatitis B virus (HBV) arena, the retrospective scrutiny of both interferon and nucleos(t) ide analogues (NIX) studies failed to provide robust evidence for HCC chemoprevention, due to a number of confoundings in the studies that were originally designed to assess the antiviral activity of interferon therapy. However, the reanalysis of outcomes following patients stratification for risk factors of HCC, provided a clue to find an association between NUC therapy and a reduced risk of liver cancer in non cirrhotic patients, only. In the hepatitis C scenario, a meta analysis of 30 observational studies of patients treated with interferon demonstrated a more than 70% reduction of HCC risk occurring independently of severity of underlying liver fibrosis which was less pronounced in aged patients and those with more advanced liver fibrosis. While the reasons for the residual risk of HCC in virological responders remain largely unexplained, international societies recommend surveillance for HCC of both HBV and HCV responders to antiviral therapy. (C) 2014 Elsevier Ltd. All rights reserved.