Nahon Pierre, Vo Quang Erwan, Ganne-Carrié Nathalie
AP-HP, Hôpital Avicenne, Liver Unit, 93000 Bobigny, France.
"Equipe labellisée Ligue Contre le Cancer", Université Paris 13, Sorbonne Paris Cité, 93206 Saint-Denis, France.
J Clin Med. 2021 Jan 19;10(2):353. doi: 10.3390/jcm10020353.
Hepatocellular carcinoma (HCC) incidence has dramatically decreased in patients infected with HCV and HBV due to the widespread use of highly effective antiviral agents. Nevertheless, a substantial proportion of patients with advanced fibrosis or cirrhosis following HCV clearance of in case of HBV control whatever the stage of fibrosis remains at risk of liver cancer development. Cancer predictors in these virus-free patients include routine parameters estimating coexisting comorbidities, persisting liver inflammation or function impairment, and results of non-invasive tests which can be easily combined into HCC risk scoring systems. The latter enables stratification according to various liver cancer incidences and allocation of patients into low, intermediate or high HCC risk probability groups. All international guidelines endorse lifelong surveillance of these patients using semi-annual ultrasound, with known sensibility issues. Refining HCC prediction in this growing population ultimately will trigger personalized management using more effective surveillance tools such as contrast-enhanced imaging techniques or circulating biomarkers while taking into account cost-effectiveness parameters.
由于高效抗病毒药物的广泛使用，丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）感染患者的肝细胞癌（HCC）发病率已大幅下降。然而，无论纤维化处于何种阶段，在HCV清除后或HBV得到控制的情况下，相当一部分患有晚期纤维化或肝硬化的患者仍有患肝癌的风险。这些无病毒患者的癌症预测指标包括评估并存合并症的常规参数、持续的肝脏炎症或功能损害，以及可轻松纳入HCC风险评分系统的非侵入性检查结果。后者能够根据不同的肝癌发病率进行分层，并将患者分为低、中、高HCC风险概率组。所有国际指南都支持对这些患者进行终身监测，每半年进行一次超声检查，但存在已知的敏感性问题。在这一不断增长的人群中完善HCC预测最终将引发个性化管理，使用更有效的监测工具，如对比增强成像技术或循环生物标志物，同时考虑成本效益参数。
