Ghouri Yezaz Ahmed, Mian Idrees, Rowe Julie H
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA.
Department of Hematology and Oncology, National Institute of Health, Bethesda, Maryland, USA.
J Carcinog. 2017 May 29;16:1. doi: 10.4103/jcar.JCar_9_16. eCollection 2017.
Since the 1970s, the epidemic of hepatocellular carcinoma (HCC) has spread beyond the Eastern Asian predominance and has been increasing in Northern hemisphere, especially in the United States (US) and Western Europe. It occurs more commonly in males in the fourth and fifth decades of life. Among all cancers, HCC is one of the fastest growing causes of death in the US and poses a significant economic burden on healthcare. Chronic liver disease due to hepatitis B virus or hepatitis C virus and alcohol accounts for the majority of HCC cases. Incidence of nonalcoholic fatty liver disease has been on the risem and it has also been associated with the development of HCC. Its pathogenesis varies based on the underlying etiological factor although majority of cases develop in the setting of background cirrhosis. Carcinogenesis of HCC includes angiogenesis, chronic inflammation, and tumor macroenvironment and microenvironment. There is a significant role of both intrinsic genetic risk factors and extrinsic influences such as alcohol or viral infections that lead to the development of HCC. Understanding its etiopathogenesis helps select appropriate diagnostic tests and treatments.
自20世纪70年代以来，肝细胞癌（HCC）的流行已超出东亚地区的主导范围，在北半球呈上升趋势，尤其是在美国和西欧。它更常见于40至50岁的男性。在所有癌症中，HCC是美国增长最快的死亡原因之一，给医疗保健带来了巨大的经济负担。乙型肝炎病毒或丙型肝炎病毒以及酒精导致的慢性肝病占大多数HCC病例。非酒精性脂肪性肝病的发病率一直在上升，它也与HCC的发生有关。尽管大多数病例是在背景性肝硬化的情况下发生的，但其发病机制因潜在的病因因素而异。HCC的致癌过程包括血管生成、慢性炎症以及肿瘤的宏观和微观环境。内在遗传风险因素和外在影响因素（如酒精或病毒感染）在HCC的发生发展中都起着重要作用。了解其病因发病机制有助于选择合适的诊断测试和治疗方法。
