HBV相关肝细胞癌防治进展

Progress in the prevention and treatment of HBV-related hepatocellular carcinoma

HBV相关肝细胞癌(HCC)占目前中国大陆HCC总数的63.9%,HBV通过直接和间接致癌作用2个途径导致HCC产生或复发,理论上抗病毒治疗可以减少或推迟HCC的发生。核苷(酸)类似物(NAs)具有明确的循证医学证据可以减少HCC发生,最新研究提出聚乙二醇干扰素(PEG-IFN)的二级预防作用优于NAs;数据显示NAs可以有效降低治愈性手术后HCC的累积复发率,而IFN的应用可以延长患者的总生存期。HBV相关HCC的二级/三级预防应重视以下2点:重视IFN/PEG-IFN在慢性乙型肝炎患者中的合理应用,将HBV DNA<20 IU/ml和HBs Ag<1000 IU/ml作为治疗的长期控制目标。在抗病毒时代应个体化应用2类抗病毒药物,把HCC的发生率和复发率降到最低。

Hepatitis B virus（ HBV）-related hepatocellular carcinoma（ HCC） accounts for 63. 9% of all HCC cases in China's Mainland.HBV leads to the development or recurrence of HCC in a direct or indirect way. Theoretically,anti-HBV therapy can reduce or delay the development of HCC. There has been convincing evidence that nucleos（ t） ide analogues（ NAs） can reduce the development of HCC,and recent studies showed that pegylated interferon（ PEG-IFN） is superior to NAs in secondary prevention; data showed that NAs are effective in reducing the cumulative recurrence rate of HCC after curative surgery,and the application of IFN can extend the overall survival of patients. Secondary/tertiary prevention of HBV-related HCC should focus on the following two points：（ 1） pay attention to the rational use of IFN/PEG-IFN in patients with chronic hepatitis B;（ 2） take HBV DNA 〈20 IU/ml and HBs Ag 1000 IU/ml as the long-term targets of control. In the antiviral era,two types of antiviral drugs should be applied individually to minimize the incidence and recurrence of HCC.