Lim E J, Torresi J
Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, 3084, Australia,
Recent Results Cancer Res. 2014;193:113-33. doi: 10.1007/978-3-642-38965-8_7.
Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer and the third leading cause of cancer-related death, and its incidence is increasing. The majority of HCC cases are associated with chronic viral hepatitis. With over 170 million individuals chronically infected with hepatitis C virus (HCV) worldwide, HCV is currently a serious global health concern, leading to chronic hepatitis, cirrhosis and HCC, thereby causing significant morbidity and mortality. With the incidence of HCV infection increasing, the problem of HCV-associated HCC is expected to worsen as well, with the majority of HCCs developing in the setting of cirrhosis. Thus, it is imperative to provide antiviral therapy to infected individuals prior to the development of established cirrhosis in order to reduce the risk of subsequent HCC. Indeed, the successful eradication of HCV is associated with clinical and histological improvement as well as a greatly reduced risk of subsequent HCC development. Even after the development of cirrhosis, successful viral clearance is still associated with reduced HCC risk. Current standard of care antiviral treatment consists of pegylated interferon-α and ribavirin, but viral clearance rates are suboptimal with this regimen, especially in difficult to treat cohorts. However, there is a myriad of different classes of HCV-specific direct-acting antiviral agents currently in development, which can be used in combination with one another or with standard of care treatment to improve HCV cure rates. Preventative and therapeutic vaccines against HCV remain an area of ongoing research with good progress towards developing an effective vaccine in the future.
肝细胞癌（HCC）是第五大常见癌症，也是癌症相关死亡的第三大主要原因，并且其发病率正在上升。大多数HCC病例与慢性病毒性肝炎相关。全球有超过1.7亿人慢性感染丙型肝炎病毒（HCV），HCV目前是一个严重的全球健康问题，可导致慢性肝炎、肝硬化和HCC，从而造成显著的发病率和死亡率。随着HCV感染发病率的增加，HCV相关HCC的问题预计也会恶化，大多数HCC在肝硬化背景下发生。因此，必须在已确诊肝硬化之前为感染个体提供抗病毒治疗，以降低后续发生HCC的风险。事实上，成功根除HCV与临床和组织学改善以及后续发生HCC的风险大幅降低相关。即使在肝硬化发生后，成功的病毒清除仍与HCC风险降低相关。当前的标准抗病毒治疗方案包括聚乙二醇化干扰素-α和利巴韦林，但该方案的病毒清除率不理想，尤其是在难治性人群中。然而，目前有多种不同类别的HCV特异性直接抗病毒药物正在研发中，它们可以相互联合使用或与标准治疗方案联合使用以提高HCV治愈率。针对HCV的预防性和治疗性疫苗仍是一个正在进行研究的领域，在未来开发有效疫苗方面取得了良好进展。
