Am Soc Clin Oncol Educ Book. 2018 May 23;(38):262-279. doi: 10.1200/EDBK_200939.
Global Epidemiology, Prevention, and Management of Hepatocellular Carcinoma.
Mak LY1, Cruz-Ramón V1, Chinchilla-López P1, Torres HA1, LoConte NK1, Rice JP1, Foxhall LE1, Sturgis EM1, Merrill JK1, Bailey HH1, Méndez-Sánchez N1, Yuen MF1, Hwang JP1.
Author information
1
From the Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; Liver Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; University of Wisconsin School of Medicine, Madison, WI; American Society of Clinical Oncology, Alexandria, VA.
Abstract
The incidence rate of hepatocellular carcinoma (HCC) is rising. It is one of the most common cancers worldwide and accounts for substantial morbidity and mortality. Chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection, and nonalcoholic fatty liver disease (NAFLD) are the most important etiologies of HCC, and effective screening and management strategies are crucial to reduce the HCC risk. For HBV, which accounts for the majority of HCC cases, most infections were acquired via perinatal and early horizontal transmission. Universal vaccination of newborns has led to a decline in HCC incidence compared with the pre-vaccination era. Effective antiviral therapies with nucleos(t)ide analogues or pegylated interferon reduced the incidence of HCC. For HCV, the emergence of effective direct-acting antiviral (DAA) agents has substantially improved cure rates; therefore all patients with HCV should be considered for DAA treatment. The most important obstacle in eliminating HCV is access to therapy. For NAFLD, the global incidence is increasing rapidly, thus its impact on HCC incidence may be explosive. Progression to HCC in NAFLD happens particularly in those with nonalcoholic steatohepatitis (NASH) and exacerbated by metabolic syndrome, or PNPLA3 gene polymorphism. Lifestyle changes are imperative while drug therapy has yet to demonstrate substantive protective effects on HCC prevention. For management of HCC, early diagnosis via imaging surveillance among persons with HCC risk factors remains the most important strategy to identify early-stage disease appropriate for resection or transplantation.
1
来自香港大学玛丽医院医学系，中国香港;墨西哥墨西哥城Medica Sur Clinic and Foundation肝脏研究所;德克萨斯大学MD安德森癌症中心，德克萨斯州休斯顿;威斯康星大学Carbone癌症中心，威斯康星州麦迪逊;威斯康星大学医学院，麦迪逊，威斯康星州;美国弗吉尼亚州亚历山大市临床肿瘤学会。