肝癌患者治疗中的抗病毒治疗

HCV Cirrhosis
HIV/HBV coinfection
Herbst DA, Reddy KR. Clin Liv Dis, 2012, 1(6):180
Nonviral Cirrhosis-related Factors and Environmental Factors That Can Lead to the Development of HCC
1% to 8% per year in individuals with cirrhosis 3%-8% per year) among those with viral hepatitis (particularly HCV)
▪ Obesity and diabetes, often contributing to fatty liver disease, are also independent
African/North American blacks with HBV
Incidence of HCC 3%-8% /year 3%-5% /year 3％-5％ /year Unknow but probably >1.5% /year Unknown 0.4%-0.6% /year 0.3%-0.6% /year
Cirrhosis-Related Risk Factors Genetic hemochromatosis Autoimmune liver disease
Primary biliary cirrhosis Autoimmune hepatitis Hereditary tyrosinemia Alpha-1-antitrypsin deficiency NAFLD/NASH Obesity Diabetes melitus
risk factors for the development of HCC and may act synergistically with other risk factors such as viral hepatitis.
▪ Coinfection with HIV is also an additive risk factor for HCC in patients with chronic viral
EI-Serag HB. Gastroenterology, 2012, 142: 1264-1273.
Viral Predisposing Conditions for the Development of HCC
HBV Cirrhosis Noncirrhosis
Longer duration of infection Increased degree of viremia East Asian ethnicities Sub-Saharan Africa ethnicities African males Genotype A (prevalent among Africans) Genotype C (prevalent among Asians) Family history of HCC
Population Groups Cirrhotic HBV carriers HCV cirrhosis Stage 4 Primary biliary cirrhosis Genetic hemochromatosis and cirrhosis Other cirrhosis Male Asian HBV carriers older than 40 years Female Asian HBV carriers older than 50 years HBV carriers with a family history of HCC
hepatitis.
▪ Smokers have a higher risk than nonsmokers. ▪ In all populations, HCC has a strong male preponderance, with the male-to-female
ratio estimated to be 2.4
肝癌患者治疗中的 抗病毒治疗
Natural History of Chronic Liver Disease
Chronic hepatitis with fibrosis 10-50 yrs
Hepatocellular Carcinoma
HBV
HCV
Normalwk.baidu.comliver
Cirrhosis
Liver Transplant
Higher than incidence without a family history HCC occurs at a younger age
Herbst DA, Reddy KR. Clin Liv Dis, 2012, 1(6):180
The Viral Related Pathogenesis of HCC
Direct oncogenic contributions
HBV DNA may integrate into cellular DNA induces genetic alterations (e.g., chromosomal instability, and host gene expression modification, i.e., cis-activation)
Environmental Risk Factors Heavy alcohol consumption Cigarette smoking Aflatoxin exposure
Herbst DA, Reddy KR. Clin Liv Dis, 2012, 1(6):180
Relative Risk and Incidence of Developing HCC by Group
肝癌发生的特点和危险因素
▪ HCC (approximately 90%) are associated with a known risk factor. i.e. HBV infection
(>50%)
▪ Cirrhosis of any cause is an important risk factor for the development of HCC.