Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Ann Hepatol. 2012 May-Jun;11(3):284-93.
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer deaths in men. Due to differences in the prevalence of viral hepatitis, the incidence of HCC in low and middle income countries is much higher than that of high income countries. Strategies to limit the impact of HCC include primary prevention against new cases of viral hepatitis, secondary prevention of HCC in susceptible individuals, and early HCC detection. Universal hepatitis B vaccination has resulted in dramatic reduction in incident cases of chronic hepatitis B and HCC in children and adolescents, and the full effect is expected in the next 20 years. The key hurdle for universal vaccination is the cost and the accessibility in low and middle income countries. Randomized controlled trials and meta-analyses showed that successful treatment of chronic hepatitis B and C can reduce the risk of HCC and cirrhotic complications. HCC surveillance by regular ultrasound examination and alpha fetoprotein testing leads to early cancer detection and offers the opportunity for curative treatment. Since all these measures are costly and require manpower and infrastructure support, the implementation should rely on the liaison among healthcare providers and policymakers. The cost-effectiveness of various strategies should also be studied based on local situations.
肝细胞癌（HCC）是第五种最常见的癌症，也是男性癌症死亡的第二大主要原因。由于病毒性肝炎的流行率存在差异，中低收入国家的 HCC 发病率远高于高收入国家。限制 HCC 影响的策略包括针对新的病毒性肝炎病例的一级预防、对易感个体的 HCC 的二级预防，以及早期 HCC 检测。乙型肝炎疫苗的普及接种已导致儿童和青少年中慢性乙型肝炎和 HCC 的发病率大幅下降，预计在未来 20 年内将产生全面效果。普及接种的主要障碍是成本和中低收入国家的可及性。随机对照试验和荟萃分析表明，成功治疗慢性乙型肝炎和丙型肝炎可以降低 HCC 和肝硬化并发症的风险。通过定期超声检查和甲胎蛋白检测进行 HCC 监测可实现早期癌症检测，并提供根治性治疗机会。由于所有这些措施都很昂贵，并且需要人力和基础设施的支持，因此实施应依靠医疗保健提供者和政策制定者之间的联系。还应根据当地情况研究各种策略的成本效益。
