肝细胞癌的全球观点：趋势，风险，预防和管理

StephenW

A global view of hepatocellular carcinoma: trends, risk, prevention and management

    Ju Dong Yang, Pierre Hainaut, Gregory J. Gores, Amina Amadou, Amelie Plymoth & Lewis R. Roberts

Nature Reviews Gastroenterology & Hepatologyvolume 16, pages589–604 (2019) | Download Citation
Article metrics

    2045 Accesses

    1 Citations

    30 Altmetric

    Metrics details

Abstract

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
Key points

    Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide; >80% of HCC cases occur in low-resource and middle-resource countries, particularly in Eastern Asia and sub-Saharan Africa, where medical and social care resources are often constrained.

    Prevention and treatment of viral hepatitis and mitigation of exposure to aflatoxin and aristolochic acid, the main risk factors in high-incidence regions, are critical for decreasing the global burden of HCC.

    HCC surveillance enables early detection and increases the chance of potentially curative treatment; therefore, broad implementation of HCC surveillance in high-risk patients is essential to reduce the high mortality from HCC.

    Early-stage HCC is amenable to potentially curative treatment, which includes local ablation, surgical resection and liver transplantation.

    Catheter-based locoregional treatment is indicated in patients with intermediate-stage disease; kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC.

    Global reduction of HCC burden can be achieved by universal HBV vaccination, control of chronic viral hepatitis, avoiding environmental and lifestyle risk factors, and improving early detection and management.

StephenW

肝细胞癌的全球观点：趋势，风险，预防和管理

    朱东阳，皮埃尔·海诺（Pierre Hainaut），格雷戈里·戈尔（Gregory J.

自然评论，胃肠病和肝病，第16卷，第589–604页（2019）|下载引文
文章指标

    2045次访问

    1引文

    30高度

    指标详细信息

抽象

肝细胞癌（HCC）是全世界与癌症相关的死亡的第四大最常见原因。肝癌的危险因素包括慢性乙型肝炎和丙型肝炎，酒精成瘾，代谢性肝病（尤其是非酒精性脂肪肝疾病）以及接触饮食毒素（如黄曲霉毒素和马兜铃酸）。所有这些风险因素都是可以预防的，突出了风险预防在减轻全球HCC负担方面的巨大潜力。肝癌的监测和早期发现增加了潜在治疗的机会；但是，即使在拥有足够医疗资源的国家中，HCC监控的使用也大大不足。早期HCC可以通过局部消融，手术切除或肝移植进行治疗。治疗的选择取决于肿瘤的特征，潜在的肝功能不全的严重程度，年龄，其他合并症，可利用的医疗资源和当地专家。基于导管的局部治疗被用于患有中期癌症的患者。激酶和免疫检查点抑制剂已被证明是晚期肝癌患者的有效治疗选择。合理地部署预防措施，实现消除病毒性肝炎的全球目标以及改善HCC监测和治疗，共同为在未来几十年内大幅降低全球HCC负担提供了希望。
关键点

    肝细胞癌（HCC）是全球癌症相关死亡的第四大最常见原因；超过80％的HCC病例发生在资源匮乏和资源中等的国家，尤其是在经常限制医疗和社会护理资源的东亚和撒哈拉以南非洲地区。

    预防和治疗病毒性肝炎以及减轻高发地区的主要危险因素黄曲霉毒素和马兜铃酸的暴露，对于减轻全球HCC负担至关重要。

    HCC监测可及早发现并增加可能的治愈性治疗机会；因此，在高危患者中广泛实施HCC监测对于降低HCC的高死亡率至关重要。

    早期HCC可以接受潜在的治疗，包括局部消融，手术切除和肝移植。

    患有中期疾病的患者应进行基于导管的局部治疗。激酶和免疫检查点抑制剂已被证明是晚期肝癌患者的有效治疗选择。

    可以通过普遍的HBV疫苗接种，控制慢性病毒性肝炎，避免环境和生活方式的危险因素以及改善早期发现和管理来在全球范围内降低HCC负担。