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肝胆相照论坛

 

 

肝胆相照论坛 论坛 学术讨论& HBV English 全球流行病学,预防和治疗肝细胞癌。
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全球流行病学,预防和治疗肝细胞癌。 [复制链接]

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才高八斗

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发表于 2018-9-22 16:16 |只看该作者 |倒序浏览 |打印
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.

PMID:
    30231359
DOI:
    10.1200/EDBK_200939

Rank: 8Rank: 8

现金
62111 元 
精华
26 
帖子
30437 
注册时间
2009-10-5 
最后登录
2022-12-28 

才高八斗

2
发表于 2018-9-22 16:17 |只看该作者
Am Soc Clin Oncol Educ Book。 2018年5月23日;(38):262-279。 doi:10.1200 / EDBK_200939。
全球流行病学,预防和治疗肝细胞癌。
Mak LY1,Cruz-RamónV1,Chinchilla-LópezP1,Torres HA1,LoConte NK1,Rice JP1,Foxhall LE1,Sturgis EM1,Merrill JK1,Bailey HH1,Méndez-SánchezN1,Yuen MF1,Hwang JP1。
作者信息

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。

抽象

肝细胞癌(HCC)的发病率正在上升。它是世界上最常见的癌症之一,并且导致大量的发病率和死亡率。慢性乙型肝炎病毒(HBV)感染,慢性丙型肝炎病毒(HCV)感染和非酒精性脂肪性肝病(NAFLD)是HCC最重要的病因,有效的筛查和管理策略对降低HCC风险至关重要。对于大多数HCC病例的HBV,大多数感染是通过围产期和早期水平传播获得的。与疫苗接种前相比,新生儿的普遍接种导致HCC发病率下降。核苷(t)ide类似物或聚乙二醇化干扰素的有效抗病毒疗法降低了HCC的发病率。对于HCV,有效的直接作用抗病毒(DAA)药剂的出现大大提高了治愈率;因此,所有HCV患者都应考虑进行DAA治疗。消除HCV的最重要障碍是获得治疗。对于NAFLD,全球发病率正在迅速增加,因此其对HCC发病率的影响可能具有爆油炸性。 NAFLD中HCC的进展尤其发生在患有非酒精性脂肪性肝炎(NASH)并且由代谢综合征或PNPLA3基因多态性加剧的患者中。生活方式的改变势在必行,而药物治疗尚未对HCC预防产生实质性的保护作用。对于HCC的管理,通过HCC风险因素患者的成像监测进行早期诊断仍然是识别适合切除或移植的早期疾病的最重要策略。
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