Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine, Houston Center for Quality of Care and Utilization Studies, Houston, Texas, USA.
Hepatol Res. 2007 Sep;37 Suppl 2:S88-94. doi: 10.1111/j.1872-034X.2007.00168.x.
Hepatocellular carcinoma (HCC) is increasing in frequency the USA. Age-adjusted incidence, hospitalization, and mortality rates have doubled over the past two decades. There are striking differences in the incidence of HCC related to age, gender, race, and geographic region. Although it remains an affliction of the elderly (mean age 65), there has been a considerable shift toward younger cases. There is a birth cohort effect with those born after 1945. Men are affected three times more frequently than women, Asians two times more than African American and Hispanic people, who are affected two times more often than Caucasians. However, the recent increase has disproportionately affected Caucasian (and Hispanic) men between ages 45 and 65. Hepatitis C virus (HCV) infection acquired 2-4 decades ago explains at least half of the observed increase in HCC; HCV-related HCC is likely tocontinue to increase for the next decade. A variable but significant proportion of cases (15-50%) do not have evidence for the risk factors of either viral hepatitis or heavy alcohol consumption. Insulin resistance syndrome manifesting as obesity and diabetes is emerging as a risk factor for HCC in the USA and may operate through the formation of non-alcoholic fatty liver disease (NAFLD); however, its effect on the current trend in HCC remains unclear. While there has been a small recent improvement in survival, it remains generally dismal (median 8 months). Population-based data in the USA indicate low application rate of HCC potentially curative therapy and marked regional differences.
肝细胞癌 (HCC) 在 美国的发病率正在上升。在过去的二十年中，年龄调整后的发病率、住院率和死亡率翻了一番。与年龄、性别、种族和地理位置相关的 HCC 发病率存在显著差异。尽管它仍然是老年人的疾病（平均年龄 65 岁），但年轻患者的比例有了相当大的增加。出生队列效应在 1945 年后出生的人群中更为明显。男性的发病率是女性的三倍，亚洲人的发病率是非洲裔美国人和西班牙裔人的两倍，而非洲裔美国人和西班牙裔人的发病率是白种人的两倍。然而，最近的增长不成比例地影响了 45 至 65 岁的白种人（和西班牙裔）男性。二十至四十年前获得的丙型肝炎病毒 (HCV) 感染至少解释了 HCC 观察到的增长的一半；HCV 相关 HCC 可能在未来十年继续增加。一个变量但相当大比例的病例（15-50%）没有证据表明病毒性肝炎或大量饮酒的危险因素。肥胖和糖尿病表现为胰岛素抵抗综合征正在成为美国 HCC 的一个危险因素，并可能通过形成非酒精性脂肪性肝病 (NAFLD) 起作用；然而，它对 HCC 目前的趋势的影响尚不清楚。虽然最近的生存率略有提高，但总体仍然很糟糕（中位数 8 个月）。美国的人群数据表明 HCC 潜在治愈性治疗的应用率较低且存在明显的地区差异。
