Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy.
Int J Mol Sci. 2022 Jan 2;23(1):500. doi: 10.3390/ijms23010500.
Hepatocellular carcinoma (HCC) is one of the major causes of cancer-related death. Although the burden of alcohol- and NASH-related HCC is growing, chronic viral hepatitis (HBV and HCV) remains a major cause of HCC development worldwide. The pathophysiology of viral-related HCC includes liver inflammation, oxidative stress, and deregulation of cell signaling pathways. HBV is particularly oncogenic because, contrary to HCV, integrates in the cell DNA and persists despite virological suppression by nucleotide analogues. Surveillance by six-month ultrasound is recommended in patients with cirrhosis and in "high-risk" patients with chronic HBV infection. Antiviral therapy reduces the risks of development and recurrence of HCC; however, patients with advanced chronic liver disease remain at risk of HCC despite virological suppression/cure and should therefore continue surveillance. Multiple scores have been developed in patients with chronic hepatitis B to predict the risk of HCC development and may be used to stratify individual patient's risk. In patients with HCV-related liver disease who achieve sustained virological response by direct acting antivirals, there is a strong need for markers/scores to predict long-term risk of HCC. In this review, we discuss the most recent advances regarding viral-related HCC.
肝细胞癌 (HCC) 是癌症相关死亡的主要原因之一。尽管酒精和 NASH 相关 HCC 的负担正在增加，但慢性病毒性肝炎 (HBV 和 HCV) 仍然是全球 HCC 发展的主要原因。病毒相关 HCC 的病理生理学包括肝脏炎症、氧化应激和细胞信号通路失调。HBV 特别致癌，因为与 HCV 不同，HBV 整合到细胞 DNA 中，并在核苷酸类似物抑制病毒复制后仍然存在。建议对肝硬化患者和慢性 HBV 感染的“高危”患者进行每 6 个月一次的超声监测。抗病毒治疗可降低 HCC 发展和复发的风险；然而，尽管病毒抑制/治愈，晚期慢性肝病患者仍有 HCC 风险，因此应继续监测。已经为慢性乙型肝炎患者开发了多种评分来预测 HCC 发展的风险，并可用于分层个体患者的风险。在 HCV 相关肝病患者中，直接作用抗病毒药物可实现持续病毒学应答，因此强烈需要标志物/评分来预测 HCC 的长期风险。在这篇综述中，我们讨论了与病毒相关 HCC 相关的最新进展。
