Chen Jian-Guo, Kensler Thomas W, Zhu Jian, Zhu Yuan-Rong, Wang Jin-Bing, Lu Jian-Hua, Muñoz Alvaro, Groopman John D
Qidong Liver Cancer Institute, Qidong People's Hospital, Affiliated Qidong Hospital of Nantong University, Nantong, China.
Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Int J Cancer. 2025 Feb 15;156(4):756-763. doi: 10.1002/ijc.35198. Epub 2024 Sep 21.
Liver cancer causes upwards of 1 million cancer deaths annually and is projected to rise by at least 55% over the next 15 years. Two of the major risk factors contributing to liver cancer have been well documented by multiple epidemiologic studies and the hepatitis B virus (HBV) and aflatoxin show a synergy that increases by more than 8-fold the risk of liver cancer relative to HBV alone. Using the population-based cancer registry established by the Qidong Liver Cancer Institute in 1972 and aflatoxin-specific biomarkers, we document that reduction of aflatoxin exposure has likely contributed to a nearly 70% decline in age-standardized liver cancer incidence over the past 30 years despite an unchanging prevalence of HBV infection in cases. A natural experiment of economic reform in the 1980s drove a rapid switch from consumption of heavily contaminated corn to minimally, if any, contaminated rice and subsequent dietary diversity. Aflatoxin consumption appears to accelerate the time to liver cancer diagnosis; lowering exposure to this carcinogen adds years of life before a cancer diagnosis. Thus, in 1990 the median age of diagnosis was 48 years, while increasing to 67 years by 2021. These findings have important translational public health implications since up to 5 billion people worldwide might be routinely exposed to dietary aflatoxin, especially in societies using corn as the staple food. Interventions against aflatoxin are an achievable outcome leading to a reduction in liver cancer incidence and years of delay of its nearly always fatal diagnosis.
肝癌每年导致超过100万人死于癌症，预计在未来15年内至少上升55%。多项流行病学研究已充分证明，导致肝癌的两个主要风险因素是乙肝病毒（HBV）和黄曲霉毒素，二者具有协同作用，相对于单独感染HBV，其导致肝癌的风险增加了8倍多。利用启东肝癌研究所1972年建立的基于人群的癌症登记处以及黄曲霉毒素特异性生物标志物，我们记录到，尽管病例中HBV感染率没有变化，但在过去30年里，黄曲霉毒素暴露的减少可能使年龄标准化肝癌发病率下降了近70%°20世纪80年代的一项经济改革自然实验促使人们迅速从食用严重污染的玉米转向食用污染最小（如果有污染的话）的大米以及随后的饮食多样化。黄曲霉毒素的摄入似乎会加速肝癌诊断时间；减少接触这种致癌物会增加癌症诊断前的寿命。因此，1990年诊断的中位年龄为48岁，到2021年增加到67岁。这些发现具有重要的转化公共卫生意义，因为全球多达50亿人可能经常接触膳食黄曲霉毒素，尤其是在以玉米为主食的社会。针对黄曲霉毒素的干预措施是一个可以实现的结果，能够降低肝癌发病率，并延迟其几乎总是致命的诊断。
