Rigopoulou Eirini I, Dalekos George N
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, 41110 Larissa, Greece.
Cancers (Basel). 2021 Mar 1;13(5):1023. doi: 10.3390/cancers13051023.
Hepatocellular carcinoma (HCC), the commonest among liver cancers, is one of the leading causes of mortality among malignancies worldwide. Several reports demonstrate autoimmune liver diseases (AILDs), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) to confer increased risk of hepatobiliary malignancies, albeit at lower frequencies compared to other liver diseases. Several parameters have been recognized as risk factors for HCC development in AIH and PBC, including demographics such as older age and male sex, clinical features, the most decisive being cirrhosis and other co-existing factors, such as alcohol consumption. Moreover, biochemical activity and treatment response have been increasingly recognized as prognostic factors for HCC development in AIH and PBC. As available treatment modalities are effective only when HCC diagnosis is established early, surveillance has been proven essential for HCC prognosis. Considering that the risk for HCC is not uniform between and within disease groups, refinement of screening strategies according to prevailing demographic, clinical, and molecular risk factors is mandated in AILDs patients, as personalized HCC risk prediction will offer significant advantage in patients at high and/or medium risk. Furthermore, future investigations should draw attention to whether modification of immunosuppression could benefit AIH patients after HCC diagnosis.
肝细胞癌（HCC）是最常见的肝癌类型，是全球恶性肿瘤致死的主要原因之一。多项报告表明，自身免疫性肝病（AILD），包括自身免疫性肝炎（AIH）、原发性胆汁性胆管炎（PBC）和原发性硬化性胆管炎（PSC），会增加肝胆恶性肿瘤的发病风险，尽管与其他肝病相比，其发病频率较低。在AIH和PBC中，有几个参数已被确认为HCC发生的危险因素，包括人口统计学因素，如年龄较大和男性，临床特征，其中最具决定性的是肝硬化以及其他并存因素，如饮酒。此外，生化活性和治疗反应越来越被认为是AIH和PBC中HCC发生的预后因素。由于现有的治疗方式只有在早期确诊HCC时才有效，因此监测已被证明对HCC的预后至关重要。鉴于不同疾病组之间以及疾病组内HCC的风险并不一致，AILD患者必须根据当前的人口统计学、临床和分子危险因素优化筛查策略，因为个性化的HCC风险预测将为高风险和/或中等风险患者带来显著优势。此外，未来的研究应关注免疫抑制的调整是否能使HCC诊断后的AIH患者受益。
