State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Liver Int. 2020 Oct;40(10):2316-2325. doi: 10.1111/liv.14607. Epub 2020 Aug 3.
Hepatocellular carcinoma (HCC), one of the major malignant lethal tumours, is most prevalent in Asian patients with chronic hepatitis B virus (HBV) infection. Both viral and non-viral factors contribute to the development of HCC. It is established that viral factors associated with HBV DNA level, HBV genotype, designated gene mutation, HBV DNA integration, HBx protein, hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg) and HBV RNA are correlated with hepatocarcinogenesis. Before the introduction of antiviral therapy, viral factors once attracted more attention during the development of HCC. With the widespread use of antiviral therapy, predominantly nucleos(t)ide analogues (NAs), most patients with chronic hepatitis B (CHB) have achieved sustained viral control. The role of non-viral factors, especially modifiable factors, is anticipated to be reinforced in the future. Herein, we reviewed the modifiable non-viral risk factors of HBV-related HCC, in the hope of providing substantial evidence for further development of novel precautionary measures for HCC. In addition, the therapeutic interventions for reducing the risk of HCC, like potential conventional pharmaceutical interventions and lifestyle modification are also discussed in this review. Future studies that would explore the specific mechanism of HBV-related HCC development in patients with satisfactory viral control and related precision treatment are warranted.
肝细胞癌（HCC）是主要的恶性致死性肿瘤之一，在亚洲慢性乙型肝炎病毒（HBV）感染患者中最为常见。病毒和非病毒因素都促成了 HCC 的发展。现已确定与 HBV DNA 水平、HBV 基因型、指定基因突变、HBV DNA 整合、HBx 蛋白、乙型肝炎表面抗原（HBsAg）、乙型肝炎核心相关抗原（HBcrAg）和 HBV RNA 相关的病毒因素与肝癌发生有关。在抗病毒治疗引入之前，病毒因素在 HCC 的发展过程中曾受到更多关注。随着抗病毒治疗的广泛应用，主要是核苷（酸）类似物（NAs），大多数慢性乙型肝炎（CHB）患者已实现持续病毒控制。非病毒因素的作用，特别是可改变的因素，预计在未来将得到加强。在此，我们回顾了与 HBV 相关 HCC 的可改变非病毒危险因素，希望为进一步制定 HCC 的新预防措施提供实质性证据。此外，本文还讨论了降低 HCC 风险的治疗干预措施，如潜在的常规药物干预和生活方式改变。需要进一步研究在病毒控制良好的患者中探索与 HBV 相关 HCC 发展的具体机制以及相关的精准治疗。
