Wong Grace Lai-Hung
Grace Lai-Hung Wong, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China.
World J Hepatol. 2015 Aug 28;7(18):2133-5. doi: 10.4254/wjh.v7.i18.2133.
Hepatocellular carcinoma (HCC) secondary to chronic viral hepatitis is a major health problem in Asian-Pacific regions due to the endemics of chronic hepatitis B and C virus infection. HCC surveillance has been recommended to patients who are at risk to develop HCC. Unfortunately, a significant proportion of patients still died in long run due to tumor recurrence. The key components of an optimal surveillance program include an accurate tumor biomarker and optimal surveillance interval. Serum alpha-fetoprotein (AFP), despite of being the most widely used biomarker for HCC surveillance, it was criticized as neither sensitive nor specific. Other HCC biomarkers, including lectin-reactive AFP (AFP-L3), des-gamma carboxyprothrombin, are still under investigations. Recent study showed cancer-associated genome-wide hypomethylation and copy number aberrations by plasma DNA bisulfite sequencing to be accurate with both sensitivity and specificity close to 90% in detecting HCC in a case-control study. Concerning the optimal surveillance interval, we believe one size does not fit all patients. Accurate risk prediction to assist prognostication with well-validated HCC risk scores would be useful to decide the need for HCC surveillance. These key components of an optimal HCC surveillance program should be further validated at a surveillance setting.
由于慢性乙型和丙型肝炎病毒感染的流行，慢性病毒性肝炎继发的肝细胞癌（HCC）是亚太地区的一个主要健康问题。已建议对有发生HCC风险的患者进行HCC监测。不幸的是，相当一部分患者最终仍因肿瘤复发而死亡。最佳监测方案的关键组成部分包括准确的肿瘤生物标志物和最佳监测间隔。血清甲胎蛋白（AFP）尽管是用于HCC监测最广泛使用的生物标志物，但它被批评为既不敏感也不特异。其他HCC生物标志物，包括凝集素反应性AFP（AFP-L3）、去γ羧基凝血酶原，仍在研究中。最近的一项研究表明，在一项病例对照研究中，通过血浆DNA亚硫酸氢盐测序检测到的癌症相关全基因组低甲基化和拷贝数畸变在检测HCC时具有较高的准确性，敏感性和特异性均接近90%。关于最佳监测间隔，我们认为一种方案并不适用于所有患者。通过经过充分验证的HCC风险评分进行准确的风险预测以辅助预后判断，对于决定是否需要进行HCC监测将是有用的。最佳HCC监测方案的这些关键组成部分应在监测环境中进一步验证。
