Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine.
Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine.
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DOI：
10.1016/j.jhep.2017.09.016
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发表时间：
2018-03
影响因子：
25.7
通讯作者：
Hoshida Y
中科院分区：
文献类型：
--
作者：
Fujiwara N;Friedman SL;Goossens N;Hoshida Y
由病毒或代谢病因引起的慢性纤维化肝病是发展为肝细胞癌（HCC）的高风险状况。即使在完整的HCC肿瘤切除或消融后，残留肝脏中的致癌组织微环境也可能导致复发性原发性HCC肿瘤，在大多数患者中，这些肿瘤会发展为无法治愈的晚期疾病。因此，原则上，早期发现和预防HCC发展是改善患者预后的最有效策略。然而，实践指南推荐的用于早期肿瘤检测的“一刀切”HCC筛查在不到20%的目标人群中使用，并且筛查模式的性能，即，超声波和甲胎蛋白都不理想此外，对于新出现的高危患者人群（如病毒治愈后的慢性丙型肝炎和非酒精性脂肪肝）的最佳筛查策略仍存在争议。新的HCC生物标志物和成像方式可能会提高HCC检测的灵敏度和特异性。临床和分子HCC风险评分将能够精确预测HCC风险，然后为个体患者量身定制HCC筛查，以最大限度地提高其成本效益并优化有限医疗资源的分配。一些病因特异性和通用的HCC化学预防策略正在发展。流行病学和实验研究已经确定了候选的化学预防靶点和治疗方法，包括他汀类药物、抗糖尿病药物和选择性分子靶向药物，尽管它们的临床试验受到癌症发展的漫长过程的限制，需要长期、昂贵的研究。个体HCC风险预测有望通过针对高危患者的个性化化学预防来克服这一挑战，以实现精确的HCC预防，并大幅改善HCC的不良预后。
Chronic fibrotic liver disease caused by viral or metabolic etiologies is a high-risk condition for developing hepatocellular carcinoma (HCC). Even after complete HCC tumor resection or ablation, the carcinogenic tissue microenvironment in the remnant liver can give rise to recurrent de novo HCC tumors, which progress into incurable, advanced-stage disease in the majority of patients. Thus, early detection and prevention of HCC development is, in principle, the most impactful strategy to improve patient prognosis. However, practice guideline-recommended “one-size-fits-all” HCC screening for early tumor detection is utilized in less than 20% of the target population, and performance of screening modalities, i.e., ultrasound and alpha-fetoprotein is suboptimal. Furthermore, optimal screening strategies for emerging at-risk patient populations such as chronic hepatitis C after viral cure and non-cirrhotic non-alcoholic fatty liver disease remain controversial. New HCC biomarkers and imaging modalities may improve sensitivity and specificity of HCC detection. Clinical and molecular HCC risk scores will enable precise HCC risk prediction followed by tailored HCC screening for individual patients to maximize its cost-effectiveness and optimize allocation of limited medical resources. Several etiology-specific and generic HCC chemoprevention strategies are evolving. Epidemiological and experimental studies have identified candidate chemoprevention targets and therapies, including statins, anti-diabetic drugs, and selective molecular targeted agents, although their clinical testing has been limited by the lengthy process of cancer development that requires long-term, costly studies. Individual HCC risk prediction is expected to overcome the challenge by enabling personalized chemoprevention targeting high-risk patients to achieve precision HCC prevention and substantially improve the dismal prognosis of HCC.
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影响因子：
5.9
作者：
Bandiera, Simonetta;Bian, C. Billie;Hoshida, Yujin;Baumert, Thomas F.;Zeisel, Mirjam B.
通讯作者：
Zeisel, Mirjam B.
影响因子：
11.2
作者：
Cao Z;Fan-Minogue H;Bellovin DI;Yevtodiyenko A;Arzeno J;Yang Q;Gambhir SS;Felsher DW
通讯作者：
Felsher DW
影响因子：
13.5
作者：
Atiq, Omair;Tiro, Jasmin;Singal, Amit G.
通讯作者：
Singal, Amit G.
影响因子：
25.7
作者：
Bertuccio, Paola;Turati, Federica;Negri, Eva
通讯作者：
Negri, Eva
DOI：
10.1038/nrc2646
发表时间：
2009-07
期刊：
Nature reviews. Cancer
影响因子：
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作者：
通讯作者：
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