It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma(HCC)is alcohol consumption.Research in Italy and the United States concludes that the most common cause of HCC(responsible for...It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma(HCC)is alcohol consumption.Research in Italy and the United States concludes that the most common cause of HCC(responsible for 32%to 45%of HCC)is alcohol.It has recently been shown that a significant relationship between alcohol intake,metabolic changes,and hepatitis virus infection does exist.Alcohol may be a factor in the development of HCC via direct(genotoxic)and indirect mechanisms(cirrhosis).There is only one way of diagnosing HCC,which is early identification through surveillance,when curative treatments become possible.After stopping alcohol intake the risk of liver cancer decreases by 6%to 7%a year,and an estimated time period of 23 years is also needed.Therefore,surveillance is also important in former drinkers and,in our opinion,independently from the presence of compensated cirrhosis.In cases of very early stage(VES)and early stage with portal hypertension,liver transplantation is the optimal option;and in cases of associated disease,percutaneous ethanol injections,radiofrequency and microwave ablation are the ideal treatments.Despite the possibility of detecting microvascular invasion with HR,several studies and some randomized controlled trials revealed that overall survival and DSF rates in patients with VES HCC are much the same after ablation and HR.Therefore,ablation can be regarded as a firstline choice for patients with VES HCC.It is important to emphasize that the choice of treatment should be weighed carefully in the context of a multidisciplinary cancer team.展开更多
Interferon(IFN) therapy has been reported to decrease the risk of hepatocellular carcinoma(HCC) and improve survival by preventing liver-related deaths in patients with chronic hepatitis C virus(HCV) infection, while ...Interferon(IFN) therapy has been reported to decrease the risk of hepatocellular carcinoma(HCC) and improve survival by preventing liver-related deaths in patients with chronic hepatitis C virus(HCV) infection, while the role of IFN therapy on the natural history of hepatitis C related cirrhosis is still under debate. The ideal goal of therapy is to prevent the progression into end-stage disease. The use of IFN in patients with HCV compensated cirrhosis reduces the negative clinical evolution independently of the type of laboratoristic and virological response. In our experience, IFN therapy in HCV compensated cirrhosis is barely useful in prevention of HCC, as cirrhosis itself represents a risk of cancer.Some authors noted that IFN treatment reduces the risk of HCC independently of the virological response. It would probably be interesting to evaluate the efficacy of weekly low-dose pegylated(PEG)-IFN therapy in patients with HCV cirrhosis and to assess potential benefits of long-term PEG-IFN plus Ribavirin treatment.展开更多
文摘It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma(HCC)is alcohol consumption.Research in Italy and the United States concludes that the most common cause of HCC(responsible for 32%to 45%of HCC)is alcohol.It has recently been shown that a significant relationship between alcohol intake,metabolic changes,and hepatitis virus infection does exist.Alcohol may be a factor in the development of HCC via direct(genotoxic)and indirect mechanisms(cirrhosis).There is only one way of diagnosing HCC,which is early identification through surveillance,when curative treatments become possible.After stopping alcohol intake the risk of liver cancer decreases by 6%to 7%a year,and an estimated time period of 23 years is also needed.Therefore,surveillance is also important in former drinkers and,in our opinion,independently from the presence of compensated cirrhosis.In cases of very early stage(VES)and early stage with portal hypertension,liver transplantation is the optimal option;and in cases of associated disease,percutaneous ethanol injections,radiofrequency and microwave ablation are the ideal treatments.Despite the possibility of detecting microvascular invasion with HR,several studies and some randomized controlled trials revealed that overall survival and DSF rates in patients with VES HCC are much the same after ablation and HR.Therefore,ablation can be regarded as a firstline choice for patients with VES HCC.It is important to emphasize that the choice of treatment should be weighed carefully in the context of a multidisciplinary cancer team.
文摘Interferon(IFN) therapy has been reported to decrease the risk of hepatocellular carcinoma(HCC) and improve survival by preventing liver-related deaths in patients with chronic hepatitis C virus(HCV) infection, while the role of IFN therapy on the natural history of hepatitis C related cirrhosis is still under debate. The ideal goal of therapy is to prevent the progression into end-stage disease. The use of IFN in patients with HCV compensated cirrhosis reduces the negative clinical evolution independently of the type of laboratoristic and virological response. In our experience, IFN therapy in HCV compensated cirrhosis is barely useful in prevention of HCC, as cirrhosis itself represents a risk of cancer.Some authors noted that IFN treatment reduces the risk of HCC independently of the virological response. It would probably be interesting to evaluate the efficacy of weekly low-dose pegylated(PEG)-IFN therapy in patients with HCV cirrhosis and to assess potential benefits of long-term PEG-IFN plus Ribavirin treatment.
