肝细胞癌显示危险因素转移

StephenW

                Hepatocellular carcinoma shows risk factor shift  
   
Publish date: September 24, 2020
                      By        Heidi Splete   
   
               
  
   
                                                    



                        
  
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                      FROM Digestive Diseases: New Advances
   
   
                      Rates of hepatocellular carcinoma (HCC) continue to rise in the United States, but unevenly so given how the incidence has become highest in the Hispanic population, which is reflected in increased rates in the southern and western states, Hashem B. El-Serag, MD, of Baylor College of Medicine, Houston, said in a virtual presentation at the annual Digestive Diseases: New Advances, which is jointly provided by Rutgers and Global Academy for Medical Education.
      [url=https://cdn.mdedge.com/files/s3fs-public/El Serag_Hasem_HOUSTON_web.jpg][/url]Dr. Hashem B. El-Serag



  
  

In addition to this demographic shift, the risk factors for HCC are shifting, he said. Hepatitis C virus (HCV) has been the dominant risk factor for HCC; for patients with active HCV, the factors historically associated with increased HCC risk have included alcohol consumption, obesity, diabetes, coinfection, and genetics, he said.
This pattern is starting to change. In fact, for patients with active HCV, antiviral treatment with a sustained virologic response has surfaced as the most significant risk factor in the development of HCC, said Dr. El-Serag: Among these patients, sustained virologic response from direct-acting antivirals is associated with a significant reduction in HCC risk. However, it is important to recognize that a residual risk of HCC remains that doesn’t go away for several years, he noted.
                                 
   
         
        “Who are those people who got treated, got cured, and still developed HCC? Those with cirrhosis at the time of treatment,” he said. Those with cirrhosis have cumulative incidence of 1.8% per year, but those without cirrhosis had very low risk, he said.
Some good news in HCC is that rates appear to be declining among young men, and this is thought to be one of the groups who are achieving a cure of HCV, he said.
“One would hope, if goals for HCV elimination are met, that will translate into massive reduction of HCC,” he said.
“The issue now for hepatitis is finding infected patients and curing them,” he noted.
Dr. El-Serag touched on hepatitis B (HBV), which continues to be the driving force of hepatitis infections globally. However, in patients who receive and respond to antiviral treatment “there is a significant and considerable reduction in HCC in the context of hepatitis B” similar to that seen with hepatitis C. Vaccination programs for HBV have started to make the desired impact of reducing HCC in HBV-endemic areas, he noted.
However, current risk factors for HCC are related less to HCV and HBV and more to metabolic syndrome because more people are treated for HCV and HBV, Dr. El-Serag said. He went on to address the new dominant global risk factor for HCC: obesity. Based on data from multiple studies, those who are obese, defined as a body mass index greater than 30 kg/m2, carry a twofold increased risk of developing HCC, he said.
To reduce this risk, treatment targets might address intermediate factors such as abdominal obesity, said Dr. El-Serag. He cited a study published in Hepatology in which individuals in the highest tertile for waist-hip ratio had a threefold higher risk of HCC, compared with those in the lowest tertile.
In addition, consideration of obesity must include type 2 diabetes, which is often linked to obesity and occurs in approximately one-third of adults in the United States, Dr. El-Serag said.
Treatment of type 2 diabetes may make a difference in HCC risk reduction, Dr. El-Serag noted. “The impact of treatment of diabetes on HCC risk is an area of intense interest,” he said. Based on the latest research, “the bottom line is that those treated with metformin experience a 50% reduction in the risk of HCC,” he said
Dr. El-Serag also acknowledged the impact of other risk factors for HCC: the use of statins and the presence of nonalcoholic fatty liver disease (NAFLD).
Although statins have been associated with an increased risk of HCC, “I would not withhold statins for those with cardiovascular indications who also have chronic liver disease,” he said.
Dr. El-Serag noted that, among NAFLD patients, subgroups at even greater risk for HCC include those with diabetes, those older than 65 years, Hispanic race, and those with cirrhosis. These patients should be candidates for surveillance. Metabolic dysfunction traits such as obesity and diabetes are very common conditions, so it’s important to look at other, more specific factors, he added. “I hope that there will be tools to help clinicians classify or risk-stratify patients into different buckets,” he said.
Areas for further research on HCC continue to include risk stratification, mechanisms of action, and HCC prevention related to treatment of metabolic syndrome, he emphasized.
Dr. El-Serag had no financial conflicts to disclose. Global Academy for Medical Education and this news organization are owned by the same parent company.
SOURCE: El-Serag HB. Digestive Diseases: New Advances 2020.
   
   

StephenW

肝细胞癌显示危险因素转移
发布日期：2020年9月24日
通过
    海蒂·斯普利特（Heidi Splete）

来自消化系统疾病：新进展

在美国，肝细胞癌（HCC）的发病率持续上升，但是鉴于西班牙裔人群的发病率已达到最高的情况，这种情况并不均衡，这在南部和西部各州Hashem B. El-Serag，休斯敦贝勒医学院的医学博士在由罗格斯大学和全球医学教育学院联合提供的年度消化疾病：新进展的虚拟演讲中说。
El-Serag博士在休斯敦贝勒医学院医学系胃肠病学和肝病学。

Hashem B.El-Serag博士

他说，除了人口结构的变化外，肝癌的危险因素也在变化。丙型肝炎病毒（HCV）是HCC的主要危险因素。他说，对于活动性HCV患者，以往与HCC风险增加相关的因素包括饮酒，肥胖，糖尿病，合并感染和遗传学。

这种模式开始改变。 El-Serag博士说，实际上，对于活动性HCV的患者，具有持续病毒学应答的抗病毒治疗已成为HCC发生中最重要的危险因素，在这些患者中，直接作用抗病毒药引起的持续病毒学应答是与降低HCC风险相关。但是，重要的是要认识到残留的HCC风险不会消失数年，他指出。

“谁治疗，治愈并仍患有肝癌？那些在治疗时患有肝硬化的人，”他说。他说，那些患有肝硬化的人每年的累积发病率为1.8％，但是那些没有肝硬化的人的风险很低。

他说，HCC的一些好消息是年轻人中的发病率似乎正在下降，这被认为是治愈HCV的人群之一。

他说：“人们希望，如果消除HCV的目标得以实现，那将转化为HCC的大幅减少。”

他指出：“肝炎现在的问题是找到感染的患者并治愈他们。”

El-Serag博士谈到了乙型肝炎（HBV），乙型肝炎仍然是全球肝炎感染的驱动力。但是，在接受抗病毒治疗并对之产生反应的患者中，“与乙型肝炎相似，乙型肝炎患者的HCC显着显着降低”。HBV疫苗接种计划已开始产生降低HCC的预期效果他指出，在HBV流行地区。

但是，El-Serag博士说，当前的HCC危险因素与HCV和HBV的关系较小，而与代谢综合征相关，因为更多的人接受HCV和HBV的治疗。他接着谈到了新的占主导地位的全球HCC危险因素：肥胖。他说，根据多项研究得出的数据，肥胖者的体重指数（体重指数大于30 kg / m2）患肝癌的风险增加了两倍。

为了减少这种风险，El-Serag博士说，治疗目标可以解决中间因素，例如腹部肥胖。他引用了《肝病学》上发表的一项研究，该研究中，臀围比率最高的三分位数的人患肝癌的风险是最低三分位数的人的三倍。

此外，肥胖症的考虑必须包括2型糖尿病，这种疾病通常与肥胖症有关，在美国约三分之一的成年人中会发生。

El-Serag博士指出，治疗2型糖尿病可能会降低HCC风险。他说：“糖尿病治疗对肝癌风险的影响引起了广泛关注。”根据最新研究，“最重要的是，使用二甲双胍治疗的患者发生HCC的风险降低了50％，”他说

El-Serag博士还承认肝癌的其他危险因素的影响：他汀类药物的使用和非酒精性脂肪肝疾病（NAFLD）的存在。

尽管他汀类药物与增加的HCC风险有关，但他说：“对于那些有心血管适应症且也患有慢性肝病的人，我不会拒绝使用他汀类药物。”

El-Serag博士指出，在NAFLD患者中，发生HCC风险更高的亚组包括糖尿病患者，65岁以上的患者，西班牙裔和肝硬化患者。这些患者应作为监视对象。他补充说，肥胖和糖尿病等代谢功能异常是很常见的疾病，因此，重要的是要研究其他更具体的因素。他说：“我希望有工具可以帮助临床医生对患者进行分类或对患者进行风险分层。”

他强调，有关肝癌的进一步研究领域仍然包括风险分层，作用机制以及与代谢综合征治疗相关的肝癌预防。
El-Serag博士没有要披露的财务冲突。 全球医学教育学院和该新闻机构由同一母公司拥有。

消息来源：El-Serag HB。 消化系统疾病：2020年新进展。