Kaur Satinder P, Talat Arslan, Karimi-Sari Hamidreza, Grees Andrew, Chen Hao Wei, Lau Daryl T Y, Catana Andreea M
Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
Division of Gastroenterology, University of Massachusetts, Worcester, MA 01605, USA.
J Clin Med. 2022 Feb 21;11(4):1126. doi: 10.3390/jcm11041126.
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related death worldwide. Hepatitis B virus (HBV) infection is among the main risk factors for HCC. The risk of HCC is not eliminated completely after viral suppression, due to HBV DNA integrated into human chromosomes. Cirrhosis, HBV viral DNA levels, age, male gender, the immune response of the host against HBV, and a combination of obesity and diabetes are among the main risk factors for HCC. Active viral replication and long-standing active disease with inflammation are associated with a higher risk of HCC. Treatment of HBV with nucleos(t)ide analogues (NAs) decreased HCC risk by effectively decreasing viral load and inflammation. Similar risk factors have been reported in hepatitis B patients after seroclearance. Studies have reported decreased risk of HCC after seroclearance, but there were also conflicting results from a few studies indicating no difference in risk of developing HCC. The difference in HCC rates could be because of other factors such as coinfection, occult HBV infection, family history, HBV genotype, and other comorbidities. Due to the persistent risk of HCC after seroclearance, HCC surveillance is critical for early detection, especially in high-risk patients. However, long-term studies might be needed to further validate the results.
肝细胞癌（HCC）是全球第五大常见癌症，也是癌症相关死亡的第二大主要原因。乙型肝炎病毒（HBV）感染是HCC的主要危险因素之一。由于HBV DNA整合到人类染色体中，病毒抑制后HCC风险并未完全消除。肝硬化、HBV病毒DNA水平、年龄、男性、宿主对HBV的免疫反应以及肥胖与糖尿病的合并存在都是HCC的主要危险因素。病毒活跃复制和伴有炎症的长期活动性疾病与较高的HCC风险相关。用核苷（酸）类似物（NAs）治疗HBV可通过有效降低病毒载量和炎症来降低HCC风险。血清学清除后的乙型肝炎患者也有类似的危险因素报道。研究报告血清学清除后HCC风险降低，但也有一些研究结果相互矛盾，表明发生HCC的风险没有差异。HCC发生率的差异可能是由于其他因素，如合并感染、隐匿性HBV感染、家族史、HBV基因型和其他合并症。由于血清学清除后仍存在HCC的持续风险，HCC监测对于早期发现至关重要，尤其是在高危患者中。然而，可能需要长期研究来进一步验证结果。
