RISK-FACTORS AND PREVENTION OF HEPATOCELLULAR-CARCINOMA IN HCV INFECTION

Hepatocellular carcinoma (HCC) is one of the most common malignant tum ors worldwide. Several risk factors for HCC development have been iden tified, including cirrhosis, hepatitis B virus (HBV) infection, and he patitis C virus (HCV) infection. With regard to cirrhosis, multivariat e analysis indicates that alcohol abuse, HBsAg positivity, and anti-HC V seropositivity are independent variables associated with an increase d risk for HCC in the cirrhotic patient. A close relationship between chronic HBV infection and HCC has been established by epidemiological studies and laboratory investigations. Evidence indicates that HCV als o plays a leading role in development of HCC. Most patients with HCV-r elated HCC develop the tumor as a consequence of long-standing infecti on accompanied by chronic and progressive liver damage. In our study o f 290 consecutive patients with cirrhosis, patients with persistently elevated or fluctuating ALT levels had a significantly greater rate of HCC development. The mechanism of HCC development in HCV infection re mains to be elucidated. The annual cumulative risk of developing HCC i s approximately 1% in patients without cirrhosis at inclusion and 3-10 % in those with cirrhosis, depending on the stage of cirrhosis and pre sence of etiological cofactors. Although some evidence suggests that p atients infected with the HCV genotype Ib are at increased risk for de velopment of more severe liver disease, including HCC, results of our prospective study do not support a difference between cirrhotic and no ncirrhotic patients in terms of the natural course of cirrhosis and th e rate of developing HCC based on genotype. Strategies to prevent HCV- related HCC include blood screening and treatment of chronic HCV infec tion with interferon-alpha. Recent studies suggest that interferon-alp ha treatment may prevent the development of HCC in HCV infection. Furt her research is warranted.