Strategy for hepatocellular carcinoma from the view point of viral status

在我科接受肝细胞癌（HCC）切除术的患者中，约97%的患者血清中检测到乙型肝炎和/或丙型肝炎病毒。1%的患者在HCC组织中检测到乙型肝炎病毒基因。213例患者中有12例血清检测到G型肝炎病毒RNA。12例患者血清中也有乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）标志物，表明G型肝炎病毒与HCC的相关性较差。HBV感染患者的年龄比HCV感染患者年轻。HBV感染患者的肿瘤大小大于HCV感染患者。在野生型HBV和大量HBV患者中，术后HBV含量有时升高，随后丙氨酸转氨酶活性升高。在感染HBV的患者中，复发的危险因素包括血小板计数低、野生型HBV、高病毒载量、手术切缘阳性和非自发切除。HCV感染患者的危险因素有：年龄大、血清HCV RNA阳性、丙氨酸和天冬氨酸转氨酶活性高、肿瘤大（大于4cm）、多发肿瘤、门静脉侵犯。肝细胞癌切除术后干扰素治疗可能有助于预防复发。延长切除（解剖切除）适用于感染HBV的患者。对于感染HCV的患者，不仅需要肝细胞癌的完全切除，还需要针对HCV的so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.