Review article: the prevention of hepatitis B‐related hepatocellular carcinoma

Summary Background Ample evidence indicates an aetiological association of persistent hepatitis B virus (HBV) infection with hepatocellular carcinoma (HCC). Several viral, host and external risk factors for the development of HBV‐related HCC have been documented. Aims To summarise and discuss the ri...

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Bibliographic Details
Published in:Alimentary pharmacology & therapeutics 2018-07, Vol.48 (1), p.5-14
Main Authors: Lin, C.‐L., Kao, J.‐H.
Format: Article
Language:English
Subjects:
Aging
Antiviral agents
Deoxyribonucleic acid
DNA
Fibrosis
Gene deletion
Genotypes
Hepatitis
Hepatitis B
Hepatitis B e antigen
Hepatitis B surface antigen
Hepatocellular carcinoma
HIV
Human immunodeficiency virus
Infections
Interferon
Liver cancer
Particulate matter
Prevention
Prophylaxis
Risk factors
Serum levels
Transaminase
Vaccination
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Summary:Summary Background Ample evidence indicates an aetiological association of persistent hepatitis B virus (HBV) infection with hepatocellular carcinoma (HCC). Several viral, host and external risk factors for the development of HBV‐related HCC have been documented. Aims To summarise and discuss the risk stratification and the preventive strategies of HBV‐related HCC. Methods Recent published studies identified from PubMed were comprehensively reviewed. The key words included chronic hepatitis B, HBV, hepatocellular carcinoma, prevention and antiviral therapy. Results The incidence of HCC is extremely high in HBV hyperendemic areas. For HBV patients left untreated, significant risk factors for HCC include male gender, aging, advanced hepatic fibrosis, persistent serum transaminase elevation, specific HBV entry receptor (NTCP) genotype, PM2.5 exposure, HBeAg positivity, HBV genotype C/D/F, high proportion of core promoter mutation, pre‐S deletion, high serum levels of HBV DNA and HBsAg as well as co‐infection with HCV, HDV and HIV. Primary prevention of HBV‐related HCC can be achieved through universal HBV vaccination and anti‐viral prophylaxis for high viraemic mothers. The goal of secondary prevention has been reached by effective anti‐viral therapy to reduce the risk of HCC development in chronic hepatitis B patients. However, whether HCC is prevented or delayed deserves further examination. Finally, several studies confirmed the tertiary preventive effect of anti‐viral therapy in reducing risk of HCC recurrence after curative therapies. Conclusions Through the strategies of three‐level prevention, the global burden of HBV‐related HCC should decline over time and even be eliminated in conjunction with HBV cure.
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.14683