Division of Gastroenterology and Hepatology, 200 First Street SW, Rochester, MN 55905, USA.
Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Nat Rev Gastroenterol Hepatol. 2014 Jan;11(1):45-54. doi: 10.1038/nrgastro.2013.143. Epub 2013 Aug 13.
Hepatocellular carcinoma (HCC) is the third most common cause of death from cancer. The incidence and mortality of HCC are increasing in most Western countries as a result of an ageing cohort infected with chronic hepatitis C, and are expected to continue to rise as a consequence of the obesity epidemic. Chemopreventive strategies aimed at decreasing the risk or delaying the onset of HCC are needed. Universal immunization against HBV and antiviral therapy against HBV and HCV in patients with established disease has consistently been associated with reduced HCC risk, especially in patients who achieve sustained virologic response. However, the cost-effectiveness of antiviral therapy for primary HCC prevention is not known. Several commonly prescribed medications seem promising as chemopreventive agents against HCC, including statins, antidiabetic medications and aspirin. Dietary agents such as coffee, vitamin E and fish oil as well as phytochemicals might also be associated with reduced risk of HCC. Though randomized controlled trials are ideally needed to firmly establish efficacy, such chemoprevention trials are logistically and ethically challenging. Well-designed, prospective, population-based cohort studies might provide the best evidence for chemopreventive efficacy of these agents.
肝细胞癌 (HCC) 是癌症死亡的第三大常见原因。由于感染慢性丙型肝炎的老年人群，大多数西方国家 HCC 的发病率和死亡率正在增加，并且由于肥胖症的流行，预计这一数字还将继续上升。需要采取化学预防策略来降低 HCC 的风险或延缓其发病。针对 HBV 的普遍免疫接种以及针对已确诊疾病的 HBV 和 HCV 的抗病毒治疗一直与降低 HCC 风险相关，尤其是在实现持续病毒学应答的患者中。然而，抗病毒治疗对原发性 HCC 预防的成本效益尚不清楚。几种常用的药物似乎有望成为 HCC 的化学预防药物，包括他汀类药物、抗糖尿病药物和阿司匹林。咖啡、维生素 E 和鱼油等膳食剂以及植物化学物质也可能与 HCC 风险降低相关。尽管理想情况下需要进行随机对照试验来确定疗效，但这些化学预防试验在操作和伦理上都具有挑战性。精心设计的前瞻性人群队列研究可能为这些药物的化学预防效果提供最佳证据。
