Epidemiological characteristics and precise prophylaxis and control of HBV-associated primary liver cancer

Abstract

Primary liver cancer (PLC), which includes hepatocellular carcinoma (HCC, 93% in China; 75%-80% worldwide), intrahepatic cholangiocarcinoma (ICC, 4.3% in China; 10%-15% worldwide), and combined hepatocellular cholangiocarcinoma (CHC, 1.6% in China), is a global disease that brings a heavy burden to the world and the number of incidence cases is on the rise. Chronic liver injury caused by factors such as exposure to aflatoxin B1, infection with Clonorchis sinensis, heavy alcohol consumption, chronic infection with hepatitis C virus (HCV), and metabolic syndrome are all known risk factors for PLC. Notably, chronic infection with hepatitis B virus (HBV) is the major risk factor for HCC. Globally, PLC risk factors are changing from infectious causes to metabolic factors. Here, we update the mechanisms of HBV-related HCC (HBV-HCC) development, especially the effect of HBV evolution on the development of HCC. The HBV mutations, viral load, and HBV integration, together with parameters of poor liver function, are key components to define the highest-risk population of HBV-HCC. Antiviral therapy has been proven to be effective for the prevention of HBV-HCC in the highest-risk population. Non-invasive imaging combined with key markers is economical and convenient for screening early PLC. Surgical resection and liver transplantation are therapeutic options for HCC; however, postoperative recurrence reaches 70% in five years. Targeted therapy, immunotherapy, and radiotherapy can improve the survival of PLC. Active prophylaxes, including HBV vaccination, antiviral treatment, improving lifestyle to decrease chronic inflammation, and surveillance, are cost-effective in decreasing the disease burden of PLC.

Keywords

Primary liver cancer / hepatitis B virus / risk factor / hepatocellular carcinoma / prophylaxis of I-III grade

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