Risk for hepatocellular carcinoma in the course of chronic hepatitis B virus infection and the protective effect of therapy with nucleos(t)ide analogues  

作　　者：Irene Rapti Stephanos Hadziyannis 

机构地区：[1]Liver Unit and its Molecular Biology Laboratory, National and Kapodistrian University of Athens, Evgenidion Hospital of Athens [2]Athens Medical Center, National and Kapodistrian University of Athens, Evgenidion Hospital of Athens

出　　处：《World Journal of Hepatology》2015年第8期1064-1073,共10页世界肝病学杂志（英文版）（电子版）

摘　　要：Hepatocellular carcinoma(HCC) is a major health problem worldwide, representing one of the leading causes of death. Chronic hepatitis B virus(HBV) infection(CHB) is the most important etiologic factor of this tumor, accounting for the development of more than50% of the cases in the world. Primary prevention ofHCC is possible by hepatitis B vaccination conferring protection from HBV infection. However, according to the World Health Organization Hepatitis B Fact sheet N° 204(update of July 2014) globally there exists a large pool of > 240 million people chronically infected with HBV who are at risk for development of HCC. These individuals represent a target population for secondary prevention both of cirrhosis and of HCC. Since ongoing HBV replication in CHB is linked with the progression of the underlying liver disease to cirrhosis as well as with the development of HCC, effective antiviral treatment in CHB has also been evaluated in terms of secondary prevention of HCC. Currently, most patients with active CHB are subjected to long term treatment with the first line nucleos(t)ide analogues entecavir and tenofovir. These compounds are of high antiviral potency and have a high barrier to HBV resistance compared to lamivudine, adefovir dipivoxil and even telbivudine. Many studies have shown that patients under antiviral treatment, especially those in virological remission, develop less frequently HCC compared to the untreated ones. However, the risk for development of HCC cannot be eliminated. Therefore, surveillance for the development of HCC of patients with chronic hepatitis B must be lifelong or until a time in the future when new treatments will be able to completely eradicate HBV from the liver particularly in the early stages of CHB infection. In this context, the aim of this review is to outline the magnitude of the risk for development of HCC among patients with CHB, in the various phases of the infection and in relation to virus, host and environmental factors as evaluated in the world literature. MoreovHepatocellular carcinoma （HCC） is a major healthproblem worldwide, representing one of the leadingcauses of death. Chronic hepatitis B virus （HBV） infection（CHB） is the most important etiologic factor of thistumor, accounting for the development of more than50% of the cases in the world. Primary prevention ofHCC is possible by hepatitis B vaccination conferringprotection from HBV infection. However, according tothe World Health Organization Hepatitis B Fact sheet N°204 （update of July 2014） globally there exists a largepool of 〉 240 million people chronically infected withHBV who are at risk for development of HCC. Theseindividuals represent a target population for secondaryprevention both of cirrhosis and of HCC. Since ongoingHBV replication in CHB is linked with the progression ofthe underlying liver disease to cirrhosis as well as withthe development of HCC, effective antiviral treatmentin CHB has also been evaluated in terms of secondaryprevention of HCC. Currently, most patients with activeCHB are subjected to long term treatment with the firstline nucleos（t）ide analogues entecavir and tenofovir.These compounds are of high antiviral potency andhave a high barrier to HBV resistance compared tolamivudine, adefovir dipivoxil and even telbivudine.Many studies have shown that patients under antiviraltreatment, especially those in virological remission,develop less frequently HCC compared to the untreatedones. However, the risk for development of HCCcannot be eliminated. Therefore, surveillance for thedevelopment of HCC of patients with chronic hepatitis Bmust be lifelong or until a time in the future when newtreatments will be able to completely eradicate HBV fromthe liver particularly in the early stages of CHB infection.In this context, the aim of this review is to outline themagnitude of the risk for development of HCC amongpatients with CHB, in the various phases of the infectionand in relation to virus, host and environmental factorsas evaluated in the world literature. Moreover, thebe

关 键 词：Chronic hepatitis B Cirrhosis Hepatocellular carcinoma Hepatitis B virus Treatment Interferon LAMIVUDINE ADEFOVIR ENTECAVIR TENOFOVIR Virological remission Nucleos(t)ide analogues 

分 类 号：R512.62[医药卫生—内科学]