Varbobitis Ioannis, Papatheodoridis George V
Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Clin Mol Hepatol. 2016 Sep;22(3):319-326. doi: 10.3350/cmh.2016.0045. Epub 2016 Sep 25.
Hepatocellular carcinoma (HCC) is a primary concern for patients with chronic hepatitis B (CHB). Antiviral therapy has been reasonably the focus of interest for HCC prevention, with most studies reporting on the role of the chronologically preceding agents, interferon-alfa and lamivudine. The impact of interferon-alfa on the incidence of HCC is clearer in Asian patients and those with compensated cirrhosis, as several meta-analyses have consistently shown HCC risk reduction, compared to untreated patients. Nucleos(t)ide analogues also seem to have a favorable impact on the HCC incidence when data from randomized or matched controlled studies are considered. Given that the high-genetic barrier agents, entecavir and tenofovir, are mainly used in CHB because of their favorable effects on the overall long-term outcome of such patients, the most clinically important challenge is the identification of patients who require close HCC surveillance despite on-therapy virological remission. Several risk scores have been developed for HCC prediction in CHB patients. Most of them, such as GAG-HCC, CU-HCC and REACH-B, have been developed and validated in Asian untreated and treated CHB patients, but they do not seem to offer good predictability in Caucasian CHB patients for whom a newer score, PAGE-B, has been recently developed.
肝细胞癌（HCC）是慢性乙型肝炎（CHB）患者的主要担忧。抗病毒治疗一直是预防HCC的关注焦点，大多数研究报告了早期药物干扰素-α和拉米夫定的作用。干扰素-α对HCC发病率的影响在亚洲患者和代偿期肝硬化患者中更为明显，因为多项荟萃分析一致表明，与未治疗的患者相比，其可降低HCC风险。考虑随机或匹配对照研究的数据时，核苷（酸）类似物似乎也对HCC发病率有有利影响。鉴于高基因屏障药物恩替卡韦和替诺福韦因其对CHB患者总体长期预后的有利影响而主要用于CHB治疗，临床上最重要的挑战是识别出尽管治疗期间病毒学缓解但仍需要密切监测HCC的患者。已经开发了几种风险评分用于预测CHB患者的HCC。其中大多数，如GAG-HCC、CU-HCC和REACH-B，是在亚洲未治疗和已治疗的CHB患者中开发和验证的，但它们在白种人CHB患者中似乎没有很好的预测性，最近针对这类患者开发了一种新的评分PAGE-B。
