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Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma

World Journal of Gastroenterology 2011年第38期17卷 4258-4270页

作者： Yi-Fang Han Jun Zhao Li-Ye Ma Jian-Hua Yin Wen-Jun Chang Hong-Wei Zhang Guang-Wen Cao Department of Epidemiology Second Military Medical University Shanghai 200433 China Department of Hepatobiliary Surgery the 3rd Affiliated Hospital Second Military Medical University Shanghai200433 China Department of General Surgery the 1st Affiliated Hospital Second Military Medical University Shanghai200433 China

Primary liver cancer is an important cause of cancer death, and hepatocellular carcinoma （HCC） accounts for 70%-85% of total liver cancer worldwide. Chronic hepatitis B virus （HBV） infection contributes to 〉 75% of HCC cases. High serum viral load is the most reliable indicator of viral replication in predicting development of HCC. HBV genotype C is closely associated with HCC in cirrhotic patients aged 〉 50 years, whereas genotype B is associated with development of HCC in non-cirrhotic young patients and postoperative relapse of HCC. Different HBV subgenotypes have distinct patterns of mutations, which are clearly associated with increased risk of HCC. Mutations accumulate during chronic HBV infection and predict occurrence of HCC. Chronic inflammation leads to increased frequency of viral mutation via cellular cytidine deaminase induction. Mutations are negatively selected by host immunity, whereas some immuno-escaped HBV mutants are active in hepatocarcinogenesis. Inflammatory pathways contribute to the inflammation-necrosis-regeneration process, ultimately HCC. Their hallmark molecules can predict malignancy in HBV-infected subjects. Continuing inflammation is involved in hepatocarcinogenesis and closely related to recurrence and metastasis. HBV load, genotype C, viral mutations and expression of inflammatory molecules in HBV-related HCC tissues are significantly associated with poor prognosis. Imbalance between intratumoral CD8^＋T cells and regulatory T cells or Thl and Th2 cytokines in peritumoral tissues can predict prognosis of HBV-related HCC. These factors are important for developing active prevention and surveillance of HBV-infected subjects who are more likely to develop HCC, or for tailoring suitable treatment to improve survival or postpone postoperative recurrence of HCC.

关键词： Hepatitis B virus Hepatocellular carcinoma Viral load Genotype Mutation Immune cells signal-ing pathway Cytokine Prognosis

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