Department of Gastroenterology, Taipei City Hospital, Taipei, Taiwan.
Department of Psychology, National Chengchi University, Taipei, Taiwan.
Aliment Pharmacol Ther. 2018 Jul;48(1):5-14. doi: 10.1111/apt.14683. Epub 2018 May 3.
Ample evidence indicates an aetiological association of persistent hepatitis B virus (HBV) infection with hepatocellular carcinoma (HCC). Several viral, host and external risk factors for the development of HBV-related HCC have been documented.
To summarise and discuss the risk stratification and the preventive strategies of HBV-related HCC.
Recent published studies identified from PubMed were comprehensively reviewed. The key words included chronic hepatitis B, HBV, hepatocellular carcinoma, prevention and antiviral therapy.
The incidence of HCC is extremely high in HBV hyperendemic areas. For HBV patients left untreated, significant risk factors for HCC include male gender, aging, advanced hepatic fibrosis, persistent serum transaminase elevation, specific HBV entry receptor (NTCP) genotype, PM2.5 exposure, HBeAg positivity, HBV genotype C/D/F, high proportion of core promoter mutation, pre-S deletion, high serum levels of HBV DNA and HBsAg as well as co-infection with HCV, HDV and HIV. Primary prevention of HBV-related HCC can be achieved through universal HBV vaccination and anti-viral prophylaxis for high viraemic mothers. The goal of secondary prevention has been reached by effective anti-viral therapy to reduce the risk of HCC development in chronic hepatitis B patients. However, whether HCC is prevented or delayed deserves further examination. Finally, several studies confirmed the tertiary preventive effect of anti-viral therapy in reducing risk of HCC recurrence after curative therapies.
Through the strategies of three-level prevention, the global burden of HBV-related HCC should decline over time and even be eliminated in conjunction with HBV cure.
大量证据表明，持续性乙型肝炎病毒（HBV）感染与肝细胞癌（HCC）之间存在病因学关联。已经记录了几种与 HBV 相关 HCC 发生相关的病毒、宿主和外部危险因素。
总结和讨论 HBV 相关 HCC 的风险分层和预防策略。
全面回顾了从 PubMed 中确定的最近发表的研究。关键词包括慢性乙型肝炎、HBV、肝细胞癌、预防和抗病毒治疗。
HBV 高发地区 HCC 的发病率极高。对于未经治疗的 HBV 患者，HCC 的显著危险因素包括男性、年龄增长、进展性肝纤维化、持续血清转氨酶升高、特定 HBV 进入受体（NTCP）基因型、PM2.5 暴露、HBeAg 阳性、HBV 基因型 C/D/F、核心启动子突变比例高、前 S 缺失、HBV DNA 和 HBsAg 血清水平高以及合并感染 HCV、HDV 和 HIV。HBV 相关 HCC 的一级预防可以通过普遍的 HBV 疫苗接种和对高病毒血症母亲进行抗病毒预防来实现。通过有效抗病毒治疗降低慢性乙型肝炎患者发生 HCC 的风险，实现了二级预防的目标。然而，HCC 是否得到预防或延迟仍需进一步检查。最后，几项研究证实了抗病毒治疗在降低根治性治疗后 HCC 复发风险方面的三级预防作用。
通过三级预防策略，HBV 相关 HCC 的全球负担应随时间下降，甚至随着 HBV 治愈而消除。
