Kirk Gregory D, Bah Ebrima, Montesano Ruggero
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Carcinogenesis. 2006 Oct;27(10):2070-82. doi: 10.1093/carcin/bgl060. Epub 2006 May 5.
Human liver cancer, primarily hepatocellular carcinoma (HCC), is both common and lethal. Notable variation in HCC incidence rates worldwide corresponds to the prevalence and pattern of the primary etiologic factors. In summary of decades of collaborative research centered in The Gambia, West Africa, this review explores the independent and combined effects of hepatitis B virus (HBV), hepatitis C virus (HCV) and dietary aflatoxin exposure in the etiology of HCC. Through population surveys, field trials and a series of HCC case-control studies, the patterns and natural history of HBV, HCV and aflatoxin exposures have been defined within this population. These investigations have paralleled and informed the development of molecular biomarkers of these etiologic agents and contributed to understanding the complex mechanisms involved in hepatocarcinogenesis. We discuss preventive approaches to reduce the global burden of HCC, emphasizing The Gambia Hepatitis Intervention Study, a countrywide randomized controlled trial designed to document the efficacy of HB vaccination in preventing HBV infections and HBV-related HCC. By recognizing the synergy of applying molecular techniques to population-based epidemiological studies, the portfolio of Gambian research projects presented provides a model for partnering etiologic and mechanistic investigations with applied research.
人类肝癌，主要是肝细胞癌（HCC），既常见又致命。全球肝细胞癌发病率的显著差异与主要病因的流行情况和模式相对应。在总结以西非冈比亚为中心的数十年合作研究时，本综述探讨了乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和膳食黄曲霉毒素暴露在肝细胞癌病因中的独立作用和联合作用。通过人群调查、现场试验和一系列肝细胞癌病例对照研究，已确定了该人群中HBV、HCV和黄曲霉毒素暴露的模式及自然史。这些研究与这些病因学因素的分子生物标志物的开发并行，并为其提供了信息，有助于理解肝癌发生过程中涉及的复杂机制。我们讨论了减轻全球肝细胞癌负担的预防方法，重点介绍了冈比亚肝炎干预研究，这是一项全国性随机对照试验，旨在证明乙肝疫苗接种在预防HBV感染和HBV相关肝细胞癌方面的疗效。通过认识到将分子技术应用于基于人群的流行病学研究的协同作用，所展示的冈比亚研究项目组合为病因学和机制研究与应用研究的合作提供了一个模式。
