Risk factors for hepatocellular carcinoma.
Risk factors for hepatocellular carcinoma.
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DOI：
10.1002/cld.111
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发表时间：
2012-12-01
影响因子：
--
通讯作者：
Reddy, K Rajender
中科院分区：
文献类型：
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作者：
Herbst, D Alan;Reddy, K Rajender
肝细胞癌（HCC）是全球癌症相关死亡的第三大常见原因，每年约有75万新病例被诊断出来。1肝硬化患者（HCC发病率为1.5% - 6%/年）的监测策略可使平均预期寿命增加3 - 9个月。随着肝癌发病率的持续上升，有效的监测计划是必要的，以最大限度地提高患者的预后。有症状的晚期HCC预后不佳（5年预期寿命< 10%）。相比之下，在症状出现前确诊的肝癌更容易接受治疗，切除和肝移植的5年生存率均大于50%。为了使监测方案有效地最大化预期寿命结果，确定HCC的危险因素是至关重要的。发生HCC的最大危险因素是肝硬化，70% - 90%的原发性肝癌患者存在肝硬化（表1）。在此之后，乙型肝炎病毒（HBV）感染是HCC发展的重要易感因素，占所有病例的50%以上（表1）。感染乙肝病毒的人与未感染的人相比，肿瘤发展的相对风险是后者的100倍。乙肝病毒感染者和肝硬化患者的风险甚至更高。感染持续时间的延长和病毒血症程度的增加也会增加发病率。男性的风险高于女性，年龄较大的男性（65-75岁）发病率最高。6 HCC更容易在东亚和撒哈拉以南非洲地区的少数民族中发生。3非洲男性通常在较年轻时感染HBV，这大大增加了他们患肝癌的风险。乙型肝炎病毒基因型A和D在非洲人群中最为普遍；报告表明，前者的感染与发病率上升有关
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide, and each year, approximately 750,000 new cases are diagnosed. 1 Surveillance strategies for patients with cirrhosis, who have an HCC incidence of 1.5% to 6%/year, can lead to a 3 to 9 month increase in mean life expectancy. 2 As the incidence of liver cancer continues to rise, effective surveillance programs are necessary in order to maximize patient outcomes. Symptomatic advanced-stage HCC has dismal outcomes (5-year life expectancy< 10%). In comparison, liver cancer identified before the onset of symptoms is more amenable to treatment, with 5-year survival rates greater than 50% for both resection and liver transplantation. 2 For surveillance programs to be effective in maximizing life expectancy outcomes, identifying risk factors for HCC is essential.The single largest risk factor in the development of HCC is cirrhosis of any etiology, which is present in 70% to 90% of those who have primary liver cancer3 (Table 1). Following this, hepatitis B virus (HBV) infection is a significant predisposing factor for the development of HCC and accounts for more than 50% of all cases4 (Table 1). The relative risk of tumor development is 100-fold for those who are infected with HBV versus those who are not infected. The risk is even higher for those with an HBV infection and cirrhosis. 2 A longer duration of infection and an increased degree of viremia also increase the rate of occurrence. 5 Males are at greater risk than females, and incidence rates peak in males who are older (65-75 years). 6 HCC is more likely to develop in ethnic groups native to regions of East Asia and sub-Saharan Africa. 3 African males commonly contract HBV at a younger age, and this significantly increases their risk for developing liver cancer. HBV genotypes A and D are most prevalent in African populations; reports indicate that infection by the former is associated with an increased rate of