The changing pattern of epidemiology in hepatocellular carcinoma.
The changing pattern of epidemiology in hepatocellular carcinoma.
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DOI：
10.1016/s1590-8658(10)60507-5
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发表时间：
2010-07
影响因子：
4.5
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
--
作者：
Nordenstedt, Helena;White, Donna L.;El-Serag, Hashem B.
原发性肝癌(PLC)约占全球所有新诊断癌症病例的4%。本综述的目的是描述国际上肝癌发病率和死亡率的一些最新模式，并对主要病因进行概述。我们使用了两个数据库，GLOBOCAN 2002和世界卫生组织(WHO)死亡率数据库，分析了全球几个地区PLC的发病率和死亡率。年龄调整后的发病率最高(20/100,000)报告来自乙肝病毒感染流行的东南亚和撒哈拉以南非洲国家。南欧国家的发病率处于中高水平，而低发病率地区(10万分之5)包括南美洲和中美洲以及欧洲其他地区。大约80%-90%的肝细胞癌患者存在肝硬变，因此是最大的单一危险因素。主要危险因素包括乙肝病毒、丙型肝炎病毒、黄曲霉毒素，可能还有肥胖和糖尿病。乙肝病毒和丙型肝炎病毒加起来占全球所有肝细胞癌的80%-90%。尽管在未来几十年中，由于乙肝疫苗在新生儿中的广泛使用，它的重要性很可能会下降，但它仍然是全球范围内肝癌的主要危险因素。在北美、一些西方国家和日本，丙型肝炎病毒一直是肝细胞癌的主要病毒原因。肥胖和糖尿病在全球范围内正以快速增长的速度增长，如果它们被证明是肝癌的危险因素，它们将在未来导致更多的肝癌病例。
Primary liver cancer (PLC) represents approximately 4% of all new cancer cases diagnosed worldwide. The purpose of this review is to describe some of the latest international patterns in PLC incidence and mortality, as well as to give an overview of the main etiological factors. We used two databases, GLOBOCAN 2002 and the World Health Organization (WHO) mortality database to analyze the incidence and mortality rates for PLC in several regions around the world. The highest age adjusted incidence rates (>20 per 100,000) were reported from countries in Southeast Asia and sub-Saharan Africa that are endemic for HBV infection. Countries in Southern Europe have medium-high incidence rates, while low-incidence areas (<5 per 100,000) include South and Central America, and the rest of Europe. Cirrhosis is present in about 80–90% of HCC patients and is thereby the largest single risk factor. Main risk factors include HBV, HCV, aflatoxin and possibly obesity and diabetes. Together HBV and HCV account for 80–90% of all HCC worldwide. HBV continues to be the major HCC risk factor worldwide, although its importance will most likely decrease during the coming decades due to the widespread use of the HBV vaccine in the newborns. HCV has been the dominant viral cause in HCC in North America, some Western countries and Japan. Obesity and diabetes are increasing at a fast pace throughout the world, and if they are proven to be HCC risk factors, they would account for more HCC cases in the future.