Ledda Caterina, Loreto Carla, Zammit Christian, Marconi Andrea, Fago Lucrezia, Matera Serena, Costanzo Valentina, Fuccio Sanzà Giovanni, Palmucci Stefano, Ferrante Margherita, Costa Chiara, Fenga Concettina, Biondi Antonio, Pomara Cristoforo, Rapisarda Venerando
Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, I-95123 Catania, Italy.
Mol Med Rep. 2017 Feb;15(2):511-533. doi: 10.3892/mmr.2016.6046. Epub 2016 Dec 14.
Liver cancer is the second leading worldwide cause of cancer‑associated mortalities. Hepatocellular carcinoma, which accounts for the majority of liver tumors, ranks fifth among types of human cancer. Well‑established risk factors for liver cancer include the hepatitis B and C viruses, aflatoxins, alcohol consumption, and oral contraceptives. Tobacco smoking, androgenic steroids, and diabetes mellitus are suspected risk factors. Current knowledge regarding non‑infective occupational risk factors for liver cancer is inconclusive. The relevance of liver disorders to occupational medicine lies in the fact that the majority of chemicals are metabolized in the liver, and toxic metabolites generated via metabolism are the predominant cause of liver damage. However, their non‑specific clinical manifestations that are similar in a number of liver diseases make diagnosis difficult. Furthermore, concomitant conditions, such as viral hepatitis and alcohol or drug abuse, may mask liver disorders that result from occupational hepatotoxic agents and block the demonstration of an occupational cause. The identification of environmental agents that result in human cancer is a long and often difficult process. The purpose of the present review is to summarize current knowledge regarding the association of non‑infective occupational risk exposure and HCC, to encourage further research and draw attention to this global occupational public health problem.
肝癌是全球癌症相关死亡的第二大主要原因。占肝脏肿瘤大多数的肝细胞癌在人类癌症类型中排名第五。肝癌公认的风险因素包括乙型和丙型肝炎病毒、黄曲霉毒素、酒精摄入和口服避孕药。吸烟、雄激素类固醇和糖尿病被怀疑是风险因素。目前关于肝癌非感染性职业风险因素的认识尚无定论。肝脏疾病与职业医学的相关性在于，大多数化学物质在肝脏中代谢，代谢产生的有毒代谢物是肝损伤的主要原因。然而，它们在许多肝脏疾病中相似的非特异性临床表现使得诊断困难。此外，诸如病毒性肝炎以及酒精或药物滥用等伴随情况，可能掩盖职业性肝毒性物质导致的肝脏疾病，并阻碍对职业病因的证明。确定导致人类癌症的环境因素是一个漫长且往往困难的过程。本综述的目的是总结当前关于非感染性职业风险暴露与肝细胞癌关联的知识，鼓励进一步研究，并引起对这一全球职业公共卫生问题的关注。
