Strategy for hepatocellular carcinoma from the view point of viral status

在我科接受肝细胞癌切除术的患者中，约97%的患者检测到了乙肝和/或丙型肝炎病毒的血清标志物。在1%的患者肝细胞癌组织中检测到乙肝病毒基因。213例患者中有12例血清中检出庚型肝炎病毒RNA。12例患者均有乙肝病毒或丙型肝炎病毒的血清标志物，提示庚型肝炎病毒感染与丙型肝炎病毒感染的相关性较差。感染乙肝病毒的患者年龄比感染丙型肝炎病毒的患者年龄小。感染乙肝病毒的患者肿瘤体积大于感染丙型肝炎病毒的患者。在野生型和大量感染的患者中，术后HBV量有时会增加，继而丙氨酸氨基转移酶活性升高。在感染丙型肝炎的患者中，高龄、血清HCVRNA阳性、丙氨酸和天冬氨酸氨基转移酶活性高、肿瘤体积大(>4 cm)、多发肿瘤和门脉受侵是影响预后的危险因素。肝细胞癌切除后的干扰素治疗可能有助于预防复发。对于感染了HBV的患者，扩大切除(解剖切除)是必要的。对于感染了丙型肝炎的患者，不仅要彻底切除肝细胞癌，而且要采取相应的治疗策略。

Serum markers for Hepatitis B and/or C virus were detected in about 97% of patients who underwent liver resection for hepatocellular carcinoma (HCC) in our department. In 1 % of the patients, hepatitic B virus gene was detected in HCC tissue. Hepatitis G virus RNA was detected in sera in 12 of 213 patients. The 12 patients also had serum markers for hepatitis B virus (HBV) or hepatitis C virus (HCV), indicating that the hepatitis G virus has poor association with HCC.The age was younger in patients infected with HBV than in patients infected with HCV.The tumor size was larger in patients infected with HBV than in patients infected with HCV.The amount of HBV sometimes increased after operation, followed by increase in alanine aminotransferase activity, in patients with wild-type HBV and large amount of HBV.In patients infected with HBV, the risk factors for recurrence included low platelet count, wild-type HBV, high viral load, positive surgical margin, and nonantomic resection. In patients infected with HCV, the risk factors included high age, positive serum HCV RNA, high activities of alanine and aspartate aminotransferase, larged tumor size (more than 4cm), multiple tumors, and portal invasion. Interferon therapy after resection of HCC may be useful to prevent recurrence. Extended resection (anatomic resection) is indicated for patients infected with HBV.For patients infected with HCV, not only complete resection of HCC but a1so strategy for HCV are necessary.