丙型肝炎治疗后肝细胞癌的危险因素以及监测方法的研究进展

摘要/Abstract

摘要： 丙型肝炎是原发性肝癌(HCC)发生的主要病因之一。目前,世界范围内每年有150万人感染丙型肝炎病毒(HCV),有5800万慢性HCV感染者,部分患者死于HCV引起的肝硬化和HCC,丙型肝炎仍然是全球的健康威胁和疾病负担。随着新药的研发,直接抗病毒药物(DAA)的出现改善了HCV患者的预后,使绝大部分患者实现了持续病毒学应答(SVR)。虽然DAA能够有效清除HCV,在一定程度上改善患者肝脏纤维化,并且降低患者HCC的发生和复发。但是仍然有一部分患者受年龄、肝纤维化、代谢性疾病、遗传因素以及治疗方案等因素的影响,成为HCV治愈后的HCC高风险人群。因此,如何及时筛选出高风险人群并进行HCC风险预测需要得到进一步的完善与明确。本文对HCV治愈后HCC的危险因素以及监测方法做出如下综述,旨在为临床的诊断和治疗提供参考。

刘百怡, 饶慧瑛. 丙型肝炎治疗后肝细胞癌的危险因素以及监测方法的研究进展[J]. 肝脏, 2022, 27(9): 956-958.

参考文献

[1] World Health Organization (2022). Hepatitis C. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accessed 24 June, 2022).
[2] WHO. Global hepatitis report, 2017,WHO: Geneva, Switzerland, 2017.
[3] European Association for the Study of the Liver.EASL recommendations on treatment of hepatitis C: Final update of the series. J Hepatol,2020,73:1170-1218.
[4] Lockart I, Yeo MGH, Hajarizadeh B, et al. HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta-analysis. Hepatology, 2022,76:139-154.
[5] Kim NJ, Vutien P, Cleveland E, et al. Fibrosis Stage-specific Incidence of Hepatocellular Cancer After Hepatitis C Cure With Direct-acting Antivirals: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol,2022:S1542-3565(22)00438-4.
[6] Waziry R, Hajarizadeh B, Grebely J, et al. Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression. J Hepatol,2017,67:1204-1212.
[7] Rinaldi L, Perrella A, Guarino M, et al. Incidence and risk factors of early HCC occurrence in HCV patients treated with direct acting antivirals: a prospective multicentre study. J Transl Med,2019,17:292.
[8] Ioannou GN, Beste LA, Green PK, et al. Increased Risk for Hepatocellular Carcinoma Persists Up to 10 Years After HCV Eradication in Patients With Baseline Cirrhosis or High FIB-4 Scores. Gastroenterology,2019,157:1264-1278 e4.
[9] Krassenburg LAP, Maan R, Ramji A, et al. Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity. J Hepatol, 2021,74:1053-1063.
[10] Siphepho PY, Liu YT, Shabangu CS, et al. The Impact of Steatosis on Chronic Hepatitis C Progression and Response to Antiviral Treatments. Biomedicines,2021,9:1491.
[11] Carrieri P, Carrat F, Di Beo V, et al. Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors. JHEP Rep,2022,4:100481.
[12] Ohta A, Ogawa E, Murata M, et al. Impact of the PNPLA3 genotype on the risk of hepatocellular carcinoma after hepatitis C virus eradication. J Med Virol, 2022,94:5007-5014.
[13] Fujimoto A, Furuta M, Totoki Y, et al. Whole-genome mutational landscape and characterization of noncoding and structural mutations in liver cancer. Nat Genet, 2016,48:500-509.
[14] Tahata Y, Sakamori R, Yamada R, et al. Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis. Hepatol, Res,2022,
[15] Semmler G, Meyer EL, Kozbial K, et al. HCC risk stratification after cure of hepatitis C in patients with compensated advanced chronic liver disease. J Hepatol,2022,76:812-821.
[16] Lleo A, Aglitti A, Aghemo A, et al. Predictors of hepatocellular carcinoma in HCV cirrhotic patients treated with direct acting antivirals. Dig Liver Dis,2019,51:310-317.
[17] Innes H, Jepsen P, McDonald S, et al. Performance of models to predict hepatocellular carcinoma risk among UK patients with cirrhosis and cured HCV infection. JHEP Rep, 2021,3:100384.
[18] Ooka Y, Miho K, Shuntaro O, et al. Prediction of the very early occurrence of HCC right after DAA therapy for HCV infection. Hepatol Int,2018,12:523-530.
[19] Dajti E, Marasco G, Ravaioli F, et al. Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness. JHEP Rep,2021,3:100289.
[20] Ogawa E, Takayama K, Hiramine S, et al. Association between steatohepatitis biomarkers and hepatocellular carcinoma after hepatitis C elimination. Aliment Pharmacol Ther, 2020,52:866-876.
[21] Tsai YS, Huang CI, Tsai PC, et al. Circulating Let-7 Family Members as Non-Invasive Biomarkers for Predicting Hepatocellular Carcinoma Risk after Antiviral Treatment among Chronic Hepatitis C Patients. Cancers (Basel), 2022,14:2023.
[22] Debes JD, van Tilborg M, Groothuismink ZMA, et al. Levels of Cytokines in Serum Associate With Development of Hepatocellular Carcinoma in Patients With HCV Infection Treated With Direct-Acting Antivirals. Gastroenterology,2018,154:515-517 e3.