Axley Page, Ahmed Zunirah, Ravi Sujan, Singal Ashwani K
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, AL, USA.
J Clin Transl Hepatol. 2018 Mar 28;6(1):79-84. doi: 10.14218/JCTH.2017.00067. Epub 2017 Dec 17.
Hepatocellular carcinoma (HCC) is a leading cause of liver-related death worldwide. Hepatitis C virus (HCV) infection is a major cause of advanced hepatic fibrosis and cirrhosis, with significantly increased risk for development of HCC. The morbidity and mortality of HCV-related HCC remains high, as rates of HCV cirrhosis continue to increase. The long-term goal of antiviral therapy for chronic HCV is to reduce complications from cirrhosis, including HCC. The advent of new direct-acting antivirals with high rates of virological clearance has revolutionized cure of HCV infection. While the development of HCC in HCV patients who achieve disease sustained virologic response is reduced, these patients remain at risk for HCC, particularly those patients with advanced fibrosis and cirrhosis. This review outlines the epidemiology of HCC in chronic HCV, various mechanisms, risk factors and pathophysiology that contribute to this disease process, screening recommendations, and the available data on the impact of new direct-acting antiviral treatment on the development on HCC.
肝细胞癌（HCC）是全球肝脏相关死亡的主要原因。丙型肝炎病毒（HCV）感染是晚期肝纤维化和肝硬化的主要原因，发生HCC的风险显著增加。由于HCV肝硬化的发病率持续上升，HCV相关HCC的发病率和死亡率仍然很高。慢性HCV抗病毒治疗的长期目标是减少肝硬化的并发症，包括HCC。新的具有高病毒学清除率的直接抗病毒药物的出现彻底改变了HCV感染的治愈情况。虽然实现疾病持续病毒学应答的HCV患者发生HCC的情况有所减少，但这些患者仍有患HCC的风险，特别是那些患有晚期纤维化和肝硬化的患者。本综述概述了慢性HCV中HCC的流行病学、导致该疾病过程的各种机制、危险因素和病理生理学、筛查建议以及关于新型直接抗病毒治疗对HCC发生影响的现有数据。
