Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Oncology. 2011;81 Suppl 1:41-9. doi: 10.1159/000333258. Epub 2011 Dec 22.
Chronic hepatitis B (CHB) accounts for approximately 50% of the underlying etiologies for the development of hepatocellular carcinoma (HCC) worldwide. We reviewed the primary, secondary, and tertiary measures for the prevention of HCC in CHB patients. First, the most effective method is preventing the acquisition of CHB through global vaccination of infants. However, in patients already chronically infected, antiviral treatment using interferon or nucleoside analogs can prevent disease progression to cirrhosis or HCC. Studies have found viral replications indicated by a HBV DNA level to be a strong predictor for cirrhosis and HCC, irrespective of other viral and biochemical factors. Additionally, periodic surveillance using ultrasonography and serum α-fetoprotein every 3-6 months for earlier detection of HCC is also important so that curative treatments can be used. Once HCC occurs, hepatic resection is the mainstay of curative treatments. To prevent tumor recurrence after resection, adjuvant interferon treatments have been tried with promising results based on the assumption that they not only suppress viral activity but also have tumoricidal, antiangiogenetic, and antiproliferative effects. Using nucleoside analogs also has its rationale for preventing de novo tumor development in remnant liver, considering that viral replications are a strong risk factor for HCC. Optimal preventive plans should be further investigated in future studies.
慢性乙型肝炎（CHB）约占全球肝细胞癌（HCC）发展的 50%。我们回顾了 CHB 患者 HCC 的一级、二级和三级预防措施。首先，最有效的方法是通过婴儿全球疫苗接种预防 CHB 的发生。然而，对于已经慢性感染的患者，使用干扰素或核苷类似物的抗病毒治疗可以预防疾病进展为肝硬化或 HCC。研究发现，HBV DNA 水平所示的病毒复制是肝硬化和 HCC 的一个强有力的预测因素，而与其他病毒和生化因素无关。此外，通过每 3-6 个月进行超声和血清甲胎蛋白检测进行定期监测，以便更早地发现 HCC，这也很重要，这样就可以使用根治性治疗。一旦发生 HCC，肝切除术是根治性治疗的主要方法。为了防止切除后肿瘤复发，已尝试使用干扰素辅助治疗，根据假设，这些治疗不仅可以抑制病毒活性，还具有杀瘤、抗血管生成和抗增殖作用。使用核苷类似物也有其预防残留肝脏新发肿瘤的原理，因为病毒复制是 HCC 的一个强烈危险因素。在未来的研究中，应进一步探讨最佳的预防计划。
