肝癌化学预防策略

StephenW

Nature Reviews Gastroenterology & Hepatology | Review

   
Chemopreventive strategies in hepatocellular carcinoma

    Siddharth Singh,   
    Preet Paul Singh,   
    Lewis R. Roberts   
    & William Sanchez   

  
Abstract

   

Hepatocellular carcinoma (HCC) is the third most common cause of death from cancer. The incidence and mortality of HCC are increasing in most Western countries as a result of an ageing cohort infected with chronic hepatitis C, and are expected to continue to rise as a consequence of the obesity epidemic. Chemopreventive strategies aimed at decreasing the risk or delaying the onset of HCC are needed. Universal immunization against HBV and antiviral therapy against HBV and HCV in patients with established disease has consistently been associated with reduced HCC risk, especially in patients who achieve sustained virologic response. However, the cost-effectiveness of antiviral therapy for primary HCC prevention is not known. Several commonly prescribed medications seem promising as chemopreventive agents against HCC, including statins, antidiabetic medications and aspirin. Dietary agents such as coffee, vitamin E and fish oil as well as phytochemicals might also be associated with reduced risk of HCC. Though randomized controlled trials are ideally needed to firmly establish efficacy, such chemoprevention trials are logistically and ethically challenging. Well-designed, prospective, population-based cohort studies might provide the best evidence for chemopreventive efficacy of these agents.

StephenW

肝细胞癌（HCC ）是导致死亡的癌症的第三大最常见的原因。肝癌的发病率和死亡率都在增加，在大多数西方国家为感染了慢性丙型肝炎的人群老龄化的结果，并预期将继续上升的肥胖流行的结果。需要旨在降低风险或延缓肝癌发病化学预防策略。抗HBV和抗HBV抗病毒治疗和HCV患者的病情制定普遍免疫一直被降低肝癌的风险，尤其是在谁实现持续病毒学应答的患者。然而，抗病毒治疗原发性肝癌预防的成本效益是不知道。几种常用的处方药物似乎有希望作为对肝癌的化学预防剂，包括他汀类药物，抗糖尿病药物和阿司匹林。膳食剂，如咖啡，维生素E和鱼油以及植物化学物质，例如还可能患有HCC的风险降低。虽然是理想的需要随机对照试验，以牢固树立效能，例如化学预防试验是后勤和道德挑战性。精心设计的，前瞻性的，以人群为基础的队列研究可能为这些药物的化学预防功效的最好佐证。