Moukhadder Hassan M, Halawi Racha, Cappellini Maria Domenica, Taher Ali T
Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
Cancer. 2017 Mar 1;123(5):751-758. doi: 10.1002/cncr.30462. Epub 2016 Dec 1.
The incidence of hepatocellular carcinoma (HCC) in patients with thalassemia is on the rise. The 2 well recognized HCC risk factors in thalassemia are iron overload and chronic viral infection with hepatitis C. The carcinogenicity of iron is related to its induction of oxidative damage, which results in genotoxicity, and to immunologic dysregulation, which attenuates cancer immune surveillance. Chronic hepatitis B and C infections lead to necroinflammation, which can prompt progression to HCC, but an independent role of hepatitis B virus in hepatic carcinogenesis among patients with thalassemia has not been demonstrated. Screening patients who have thalassemia using magnetic resonance imaging-based liver iron concentration measurement and liver ultrasound is recommended for early detection of iron overload and HCC, respectively. Prevention primarily resides in hepatitis B vaccination, donor blood screening, hepatitis treatment, and iron chelation. Although solid data is lacking on the outcomes of HCC treatment in patients with thalassemia, a personalized approach tailored to the individual patient's comorbidities remains necessary for treatment success. Treatment modalities for HCC include surgical resection, chemoembolization, and liver transplantation, among others. Multicenter studies are needed to better explore therapeutic targets that can improve the prognosis of these patients. Cancer 2017;123:751-58. © 2016 American Cancer Society.
地中海贫血患者肝细胞癌（HCC）的发病率正在上升。地中海贫血中两个公认的HCC危险因素是铁过载和丙型肝炎慢性病毒感染。铁的致癌性与其诱导氧化损伤（导致基因毒性）以及免疫失调（削弱癌症免疫监视）有关。慢性乙型和丙型肝炎感染会导致坏死性炎症，这可能促使病情发展为HCC，但尚未证实乙型肝炎病毒在地中海贫血患者肝癌发生中的独立作用。建议对地中海贫血患者进行筛查，分别使用基于磁共振成像的肝脏铁浓度测量和肝脏超声检查，以早期发现铁过载和HCC。预防主要在于乙肝疫苗接种、供血筛查、肝炎治疗和铁螯合。尽管缺乏关于地中海贫血患者HCC治疗结果的确切数据，但针对个体患者合并症的个性化治疗方法对于治疗成功仍然是必要的。HCC的治疗方式包括手术切除、化疗栓塞和肝移植等。需要进行多中心研究，以更好地探索可改善这些患者预后的治疗靶点。《癌症》2017年；123:751 - 58。©2016美国癌症协会。
