Risk factors of hepatocellular carcinoma in Haimen, China

为了预防世界上肝癌发病率最高的海门市中国的肝细胞癌的发生，1995-1996年间，由蒙布斯霍国际科学研究项目特别癌症研究资助的一项国际多学科研究正在进行中。在饮用水中检测到微囊藻毒素，即由小溪、河流和池塘水中的藻类产生的最近被认为是肝癌促进剂的毒素。在主食花生、玉米等主食中检测到黄曲霉毒素B_1和伏马菌素等真菌毒素。迄今收集了134对病例和对照。慢性肝病的既往病史和家族史明显高于对照组。海门地区的HCCs主要与乙肝病毒有关，而与丙型肝炎病毒无关。垂直感染和水平传播均可能是肝细胞癌发病的原因。吸烟和饮酒与肝细胞癌的发病无关。ALDH2和CYP2E1基因多态性与肝细胞癌无关联。病例组肿瘤坏死因子α活性高于对照组，提示海门地区肝细胞癌与肝硬变或肝纤维化无必然关系。在海门发现了与黄曲霉毒素B_1相关的p53特异性突变。为了预防海门的肝癌，预防乙肝病毒感染是最重要的，建议减少霉菌毒素污染的食物摄入量。在这项研究中，没有检测到饮用水或微囊藻毒素与HCCs之间可能的关联。

In order to prevent hepatocellular carcinoma (HCC) in Haimen, China, where the incidence of HCC is the highest in the world, an international multidisciplinary research is now underway sponsored by the Mombusho International Scientific Research Project, Special Cancer Research during 1995-1996.Microcystins, toxins produced by the algae in the creek, river and pond water and recently alleged to be promoters of hepatocarcinogenesis, were detected in the drinking water.Mycotoxins, such as aflatoxin B_1 and fumonisins, were detected in staple food, such as peanuts and corns.So far, 134 pairs of cases and controls were collected. Past history and family history of chronic hepatic diseases in cases were more frequent than controls. HCCs in Haimen were mainly associated with hepatitis B virus (HBV) but not hepatitis C virus. Both vertical infection and horizontal transmission of HBV may be responsible for the onset of HCCs. Neither smoking nor alcohol drinking were related to the onset of HCCs. Genetic polymorphisms of ALDH2 and CYP2E1 were not associated with HCCs. The activity of TNFalpha in cases was highter than controls.HCCs in Haimen were not necessarily related to liver cirrhosis or fibrosis. Aflatoxin B_1-associated specific mutations in p53 were observed.To prevent HCCs in Haimen, prevention of HBV infection seems most important and reduced intake of mycotoxin-polluted food are advised. In this study, a possible association between drinking water or microcystins and HCCs were not detected in this study.