我国原发性肝癌的流行病学特征及精准防控

Epidemiological characteristics and precise prophylaxis and control of primary liver cancer in China

我国原发性肝癌(PLC)的分布特点是南方高于北方,沿海高于内地,农村高于城市;男女比例3:1。近20年来,PLC一直处于我国恶性肿瘤死亡原因的第二位,在中年人群(40~65岁)中年龄标化死亡率超过老年人群(65岁以上),在居65岁以下男性人群癌症死因第一位。我国PLC中肝细胞癌(HCC)和肝内胆管癌(ICC)分别占93%和3%。任何导致慢性肝损伤的因素都是PLC的原因,是Ⅰ级预防的关键。我国HCC主要原因是乙型肝炎病毒(HBV)慢性感染,占84.4%。约32%男性和9%女性HBV慢性携带者将在75岁之前死于HCC。此外,黄曲霉素暴露、肝吸虫感染、大量饮酒、代谢综合征和丙肝病毒感染等大大增加了PLC风险。乙型肝炎后HCC较其它原因导致的HCC早发10年,预后更差。界定PLC高危人群是Ⅱ级预防的关键。手术切除是早期PLC的有效治疗手段,但易术后复发,术后5年生存率约30%;ICC术后5年生存率<20%。抗HBV治疗不仅可显著降低HBV携带者HCC的发生风险,也能显著改善预后。再次手术、放疗、抗血管生成、免疫疗法、免疫和靶向联合治疗、有氧运动等均可明显提升PLC的Ⅰ~Ⅲ级预防的效果。

In China,the prevalence of primary liver cancer(PLC)is higher in the South than in the North,higher in the littoral than in the interior,and higher in the rural areas than in the urban areas.Male-to-female ratio of PLC is 3:1.In the past 20 years,PLC has been the second leading cause of cancer-related death;the age-standardized mortality in middle-aged population(40-65 years)has been higher than that in the aged population(older than 65 years);and it has been the first leading cause of cancer-related death in males younger than 65 years old.In China,hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)account for 93%and 3%in PLC,respectively.Factors that persistently cause liver damage are the cause of PLC,which are key elements for the prophylaxis of the first grade.The major cause of HCC is persistent infection with hepatitis B virus(HBV),accounting for 84.4%of HCC in China.Approximately,32%male and 9%female HBV chronic carriers are predicted to die of HCC by 75 years old.In addition,alpha-toxin exposure,infection with Clonorchis sinensis,heavy alcohol consumption,metabolic syndrome,and hepatitis C virus infection greatly increase the risk of PLC.HBV-related HCC(HBV-HCC)occurs 10 years earlier than HCC related to other causes and has poorer prognosis.Defining high-risk population of PLC is important for the prophylaxis of the second grade.Surgical resection is effective for the treatment of PLC at early stage;however,PLC is apt to recur postoperatively,with a five-year survival rate of approximately 30%after surgery.The 5-year survival rate after ICC surgery is less than 20%.Anti-HBV treatment not only decreases the occurrence of HCC in HBV-infected subjects significantly,but also greatly improves the postoperative prognosis.Surgery following the recurrence,radiation,anti-angiogenic treatment,immunotherapy,combined immunotherapy with targeted therapy,and aerobic exercise apparently improve the effect of phylaxis of I-III grade of PLC.