中国肝癌一级预防专家共识(2018)

中华预防医学会肿瘤预防与控制专业委员会感染相关肿瘤防控学组; 中华预防医学会慢病预防与控制分会; 中华预防医学会健康传播分会

doi:10.3969/j.issn.1001-5256.2018.10.008

中国肝癌一级预防专家共识(2018)

DOI: 10.3969/j.issn.1001-5256.2018.10.008

基金项目:

传染病国家科技重大专项(2012ZX10002008、2012ZX10002010、2017ZX10201201-006)；

详细信息

中图分类号: R735.7
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出版历程
- 出版日期: 2018-10-20

Strategies of primary prevention of liver cancer in China: Expert Consensus ( 2018)

Prevention of Infection Related Cancer (PIRCA) Group, Specialized Committee of Cancer Prevention and Control, Chinese Preventive Medicine Association,
Non-communicable & Chronic Disease Control and Prevention Society, Chinese Preventive Medicine Association,
Health Communication Society, Chinese Preventive Medicine Association

Research funding:

摘要

摘要:
肝癌是我国最常见的恶性肿瘤之一,其病因主要包括HBV、HCV感染和黄曲霉毒素,蓝藻毒素和多种可干预的个体行为方式在肝癌发生发展中也具有重要作用,实施肝癌病因的一级预防措施是在中国降低其疾病负担的重要途径。根据中国肝癌的流行病学特征,结合在中国人群中开展并获得的肝癌一级预防措施的证据,本专家共识探讨了乙型肝炎疫苗接种,包括针对不同HBV感染状态母亲的新生儿及儿童的乙型肝炎疫苗接种程序;慢性乙型、丙型肝炎患者的抗病毒治疗;预防和避免黄曲霉毒素及蓝藻毒素暴露;改变高危致癌风险相关的生活方式等,以期推进中国肝癌的有效预防。
- 肝肿瘤 /
- 一级预防 /
- 诊疗准则
Abstract:
Liver cancer is one of the most common cancers in China. The major risk factors are chronic infections of hepatitis B virus ( HBV) , hepatitis C virus ( HCV) , high exposure to aflatoxins. In addition, exposure to cyanotoxins and some preventable health behaviors are also recognized to contribute to liver cancer development. To relieve the disease burden, primary prevention of etiological interventions is an important strategy. Based on the liver cancer epidemiology in China and the effective evidences and results from the etiological interventions conduced in Chinese population domestically, the following strategies are recommended in the“Strategies of primary prevention of liver cancer: Expert Consensus ( 2018) ”to promote the effective prevention of liver cancer in general population. Immunization with HBV vaccines, including the immune programs to neonates, infants and children born to mothers with different status of HBV infection. Antiviral therapies to the patients with chronic hepatitis B or hepatitis C. Avoiding or reducing the exposure to aflatoxins as well as the cyanotoxins.Changing harmful life style, including quitting smoking and limiting alcohol etc.
- liver neoplasms /
- primary prevention /
- practice guideline

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参考文献(86)

[1]ZHAO P, WANG LD, LI JY.Preventive oncology[M].Beijing:People's Medical Publishing House, 2014:31-51. (in Chinese) 赵平, 王陇德, 黎钧耀.预防肿瘤学[M].北京:人民卫生出版社, 2014:31-51.

[2]WU MC, SHEN F.Liver cancer[M].Beijing:Peking University Medical Press, 2010:13. (in Chinese) 吴孟超, 沈锋.肝癌[M].北京:北京大学医学出版社, 2010:13.

[3]WANG M, WANG Y, FENG X, et al.Contribution of hepatitis Bvirus and hepatitis C virus to liver cancer in China north areas:Experience of the Chinese National Cancer Center[J].Int J Infect Dis, 2017, 65:15-21.

[4]GUYATT GH, OXMAN AD, SCHUNEMANN HJ, et al.GRADEguidelines:A new series of articles in the Journal of Clinical Epidemiology[J].J Clin Epidemiol, 2011, 64 (4) :380-382.

[5]ZUO TT, ZHENG RS, ZENG HM, et al.Analysis of liver cancer incidence and trend in China[J].Chin J Oncol, 2015, 37 (9) :691-696. (in Chinese) 左婷婷, 郑荣寿, 曾红梅, 等.中国肝癌发病状况与趋势分析[J].中华肿瘤杂志, 2015, 37 (9) :691-696.

[6]ZENG H, CHEN W, ZHENG R, et al.Changing cancer survival in China during 2003-15:A pooled analysis of 17 population-based cancer registries[J].Lancet Glob Health, 2018, 6 (5) :e555-e567.

[7]FERLAY J, SOERJOMATARAM I, ERVIK M, et al.GLOBOCAN2012 v1.0, Cancer Incidence and Mortality Worldwide:IARCCancer Base No.11[EB/OL].[2018-05-25].http://globocan.iarc.fr.

[8] CHEN WQ, LI H, SUN KX, et al.Report of cancer incidence and mortality in China, 2014[J].Chin J Oncol, 2018, 40 (1) :5-13. (in Chinese) 陈万青, 李贺, 孙可欣, 等.2014年中国恶性肿瘤发病和死亡分析[J].中华肿瘤杂志, 2018, 40 (1) :5-13.

[9] ZENG HM, CAO MM, ZHENG RS, et al.Trend analysis of mean age of diagnosis for liver cancer in cancer registry areas of China, 2000-2014[J].Chin J Prev Med, 2018, 52 (6) :573-578. (in Chinese) 曾红梅, 曹毛毛, 郑荣寿, 等.2000-2014年中国肿瘤登记地区肝癌平均发病年龄趋势分析[J].中华预防医学杂志, 2018, 52 (6) :573-578.

[10]de MARTEL C, MAUCORT-BOULCH D, PLUMMER M, et al.World-wide relative contribution of hepatitis B and C viruses in hepatocellular carcinoma[J].Hepatology, 2015, 62 (4) :1190-1200.

[11]BEASLEY RP, HWANG LY, LIN CC, et al.Hepatocellular carcinoma and hepatitis B virus.A prospective study of 22 707 men in Taiwan[J].Lancet, 1981, 2 (8256) :1129-1133.

[12]CHEN CJ, YANG HI, SU J, et al.Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level[J].JAMA, 2006, 295 (1) :65-73.

[13]YANG HI, LU SN, LIAW YF, et al.Hepatitis B e antigen and the risk of hepatocellular carcinoma[J].N Engl J Med, 2002, 347 (3) :168-174.

[14]YANG HI, SHERMAN M, SU J, et al.Nomograms for risk of hepatocellular carcinoma in patients with chronic hepatitis B virus infection[J].J Clin Oncol, 2010, 28 (14) :2437-2444.

[15]MCMAHON BJ.The natural history of chronic hepatitis B virus infection[J].Hepatology, 2009, 49 (Suppl 5) :s45-s55.

[16]YIN J, ZHANG H, HE Y, et al.Distribution and hepatocellular carcinoma-related viral properties of hepatitis B virus genotypes in Mainland China:A community-based study[J].Cancer Epidemiol Biomarkers Prev, 2010, 19 (3) :777-786.

[17]CHANG MH.Hepatitis B virus infection[J].Semin Fetal Neonatal Med, 2007, 12 (3) :160-167.

[18]BEASLEY RP, HWANG LY, LIN CC, et al.Incidence of hepatitis among students at a university in Taiwan[J].Am J Epidemiol, 1983, 117 (2) :213-222.

[19]HYAMS KC.Risks of chronicity following acute hepatitis B virus infection:A review[J].Clin Infect Dis, 1995, 20 (4) :992-1000.

[20]EDMUNDS WJ, MEDLEY GF, NOKES DJ, et al.The influence of age on the development of the hepatitis B carrier state[J].Proc Biol Sci, 1993, 253 (1337) :197-201.

[21]ZHANG HW, YIN JH, LI YT, et al.Risk factors for acute hepatitis B and its progression to chronic hepatitis in Shanghai, China[J].Gut, 2008, 57 (12) :1713-1720.

[22]LIANG X, CUI F, HADLER S, et al.Origins, design and implementation of the China GAVI project[J].Vaccine, 2013, 31 (Suppl 9) :j8-j14.

[23]SUN Z, MING L, ZHU X, et al.Prevention and control of hepatitis B in China[J].J Med Virol, 2002, 67 (3) :447-450.

[24]XIA GL, LIU CB, CAO HL, et al.Prevalence of hepatitis B and C virus infections in the general Chinese population.Results from a nationwide cross-sectional seroepidemiologic study of hepatitis A, B, C, D, and E virus infections in China, 1992[J].Int Hepatol Communicat, 1996, 5 (1) :62-73.

[25]LIANG X, BI S, YANG W, et al.Epidemiological serosurvey of hepatitis B in China-declining HBV prevalence due to hepatitis Bvaccination[J].Vaccine, 2009, 27 (47) :6550-6557.

[26] WANG FZ, ZHANG GM, SHEN LP, et al.Comparative analyze on hepatitis B seroepidemiological surveys among population aged 1-29 years in different epidemic regions of China in 1992 and 2014[J].Chin J Prev Med, 2017, 51 (6) :462-468. (in Chinese) 王富珍, 张国民, 沈立萍, 等.1992和2014年中国不同流行地区1~29岁人群乙型肝炎血清流行病学调查结果对比分析[J].中华预防医学杂志, 2017, 51 (6) :462-468.

[27]QU C, CHEN T, FAN C, et al.Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year followup of the Qidong hepatitis B intervention study:A cluster randomized controlled trial[J].PLo S Med, 2014, 11 (12) :e1001774.

[28] WANG YT, CHEN TY, ZHU J, et al.Primary prevention by hepatitis B vaccine on liver cancer in high incidence area of China[J].Chin J Prev Med, 2018, 52 (4) :402-408. (in Chinese) 王宇婷, 陈陶阳, 朱健, 等.肝癌高发区人群新生儿乙型肝炎疫苗接种对肝癌的预防效果[J].中华预防医学杂志, 2018, 52 (4) :402-408.

[29]HUTTON DW, SO SK, BRANDEAU ML.Cost-effectiveness of nationwide hepatitis B catch-up vaccination among children and adolescents in China[J].Hepatology, 2010, 51 (2) :405-414.

[30]NI YH, HUANG LM, CHANG MH, et al.Two decades of universal hepatitis B vaccination in Taiwan:Impact and implication for future strategies[J].Gastroenterology, 2007, 132 (4) :1287-1293.

[31]WU TW, LIN HH, WANG LY.Chronic hepatitis B infection in adolescents who received primary infantile vaccination[J].Hepatology, 2013, 57 (1) :37-45.

[32]XU L, WEI Y, CHEN T, et al.Occult HBV infection in antiHBs-positive young adults after neonatal HB vaccination[J].Vaccine, 2010, 28 (37) :5986-5992.

[33]WANG Y, CHEN T, LU LL, et al.Adolescent booster with hepatitis B virus vaccines decreases HBV infection in high-risk adults[J].Vaccine, 2017, 35 (7) :1064-1070.

[34]CHANG MH, CHEN CJ, LAI MS, et al.Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children.Taiwan Childhood Hepatoma Study Group[J].N Engl JMed, 1997, 336 (26) :1855-1859.

[35]CHIEN YC, JAN CF, CHIANG CJ, et al.Incomplete hepatitis Bimmunization, maternal carrier status, and increased risk of liver diseases:A 20-year cohort study of 3.8 million vaccinees[J].Hepatology, 2014, 60 (1) :125-132.

[36]PAN CQ, DUAN ZP, BHAMIDIMARRI KR, et al.An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus[J].Clin Gastroenterol Hepatol, 2012, 10 (5) :452-459.

[37]ZOU H, CHEN Y, DUAN Z, et al.Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers[J].J Viral Hepat, 2012, 19 (2) :e18-e25.

[38]XU WM, CUI YT, WANG L, et al.Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection:Amulticentre, randomized, double-blind, placebo-controlled study[J].J Viral Hepat, 2009, 16 (2) :94-103.

[39]HAN GR, CAO MK, ZHAO W, et al.A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J].J Hepatol, 2011, 55 (6) :1215-1221.

[40]HAN GR, JIANG HX, YUE X, et al.Efficacy and safety of telbivudine treatment:An open-label, prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection[J].J Viral Hepat, 2015, 22 (9) :754-762.

[41]ZHANG H, PAN CQ, PANG QM, et al.Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice[J].Hepatology, 2014, 60 (2) :468-476.

[42]PAN CQ, HAN G, WANG Y.Prevention of peripartum hepatitis Btransmission[J].N Engl J Med, 2016, 375 (15) :1497-1498.

[43]Chinese Society of Hepatology, Chinese Medical Association.Consensus on the management of hepatitis B virus infection in women of childbearing age[J].J Clin Hepatol, 2018, 34 (6) :1176-1180. (in Chinese) 中华医学会肝病学分会.感染乙型肝炎病毒的育龄女性临床管理共识[J].临床肝胆病杂志, 2018, 34 (6) :1176-1180.

[44]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[45]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C:A 2015update[J].J Clin Hepatol, 2015, 31 (12) :1961-1979. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.丙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1961-1979.

[46]TERRAULT NA, BZOWEJ NH, CHANG KM, et al.AASLDguidelines for treatment of chronic hepatitis B[J].Hepatology, 2016, 63 (1) :261-283.

[47]European Association for the Study of the Liver.EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J].J Hepatol, 2017, 67 (2) :370-398.

[48]OMATA M, CHENG AL, KOKUDO N, et al.Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma:A 2017 update[J].Hepatol Int, 2017, 11 (4) :317-370.

[49]CHIANG CJ, YANG YW, CHEN JD, et al.Significant reduction in end-stage liver diseases burden through the national viral hepatitis therapy program in Taiwan[J].Hepatology, 2015, 61 (4) :1154-1162.

[50]YU ML, LIN SM, CHUANG WL, et al.A sustained virological response to interferon or interferon/ribavirin reduces hepatocellular carcinoma and improves survival in chronic hepatitis C:A nationwide, multicentre study in Taiwan[J].Antivir Ther, 2006, 11 (8) :985-994.

[51]EL-SERAG HB, KANWAL F, RICHARDSON P, et al.Risk of hepatocellular carcinoma after sustained virological response in Veterans with hepatitis C virus infection[J].Hepatology, 2016, 64 (1) :130-137.

[52]CHEN XL, LI M, ZHANG XL.HBV genotype B/C and response to lamivudine therapy:A systematic review[J].Biomed Res Int, 2013, 2013:672614.

[53]HOU J, WANG G, WANG F, et al.Guideline of prevention and treatment for chronic hepatitis B (2015 Update) [J].J Clin Transl Hepatol, 2017, 5 (4) :297-318.

[54]WANG W, LI G, WEI YX.Status of Aflatoxin Contamination in China[J].J Anhui Agri, 2015, 43 (18) :308-309. (in Chinese) 王雯, 李岗, 魏云潇.我国食品中黄曲霉毒素污染现状的研究[J].安徽农业科学, 2015, 43 (18) :308-309.

[55]SHANK RC, BHAMARAPRAVATI N, GORDON JE, et al.Dietary aflatoxins and human liver cancer.IV.Incidence of primary liver cancer in two municipal populations of Thailand[J].Food Cosmet Toxicol, 1972, 10 (2) :171-179.

[56]ROSS RK, YUAN JM, YU MC, et al.Urinary aflatoxin biomarkers and risk of hepatocellular carcinoma[J].Lancet, 1992, 339 (8799) :943-946.

[57] WU SM, SUN ZT, WU YY, et al.Aflatoxin M1 (AFM1) in urine among residents in Beijing and Qidong[J].Chin J Oncol, 1984, 6 (3) :163-166. (in Chinese) 邬少明, 孙宗棠, 吴玉英, 等.北京及启东居民尿黄曲霉毒素M1 (AFM1) 排出水平的研究[J].中华肿瘤杂志, 1984, 6 (3) :163-166.

[58]SUN Z, LU P, GAIL MH, et al.Increased risk of hepatocellular carcinoma in male hepatitis B surface antigen carriers with chronic hepatitis who have detectable urinary aflatoxin metabolite M1[J].Hepatology, 1999, 30 (2) :379-383.

[59]MING L, THORGEIRSSON SS, GAIL MH, et al.Dominant role of hepatitis B virus and cofactor role of aflatoxin in hepatocarcinogenesis in Qidong, China[J].Hepatology, 2002, 36 (5) :1214-1220.

[60]CHEN CJ, WANG LY, LU SN, et al.Elevated aflatoxin exposure and increased risk of hepatocellular carcinoma[J].Hepatology, 1996, 24 (1) :38-42.

[61]LAI H, MO X, YANG Y, et al.Association between aflatoxin B1occupational airway exposure and risk of hepatocellular carcinoma:A case-control study[J].Tumour Biol, 2014, 35 (10) :9577-9584.

[62] ZHENG CF, ZENG H, WANG J, et al.The association between aflatoxin exposure and primary hepatocellular carcinoma risks:Acase-control study in Chongqing[J].Chin J Prev Med, 2017, 51 (6) :539-545. (in Chinese) 郑传芬, 曾惠, 王佳, 等.重庆地区黄曲霉毒素暴露与原发性肝癌关联的病例对照研究[J].中华预防医学杂志, 2017, 51 (6) :539-545.

[63]ZHANG W, HE H, ZANG M, et al.Genetic features of aflatoxinassociated hepatocellular carcinoma[J].Gastroenterology, 2017, 153 (1) :249-262.

[64]HUANG MN, YU W, TEOH WW, et al.Genome-scale mutational signatures of aflatoxin in cells, mice, and human tumors[J].Genome Res, 2017, 27 (9) :1475-1486.

[65]ZHU YR.Research progress in prevention of major risk factors of liver cancer in Qidong[J].China Cancer, 2012, 21 (10) :759-762. (in Chinese) 朱源荣.启东肝癌主要病因预防研究进展[J].中国肿瘤, 2012, 21 (10) :759-762.

[66]CHEN JG.Cancer in Qidong, China[M].Beijing:Military Medical Science Press, 2013:81-92. (in Chinese) 陈建国.启东癌症报告[M].北京:军事医学科学出版社, 2013:81-92.

[67]SUN Z, CHEN T, THORGEIRSSON SS, et al.Dramatic reduction of liver cancer incidence in young adults:28 year follow-up of etiological interventions in an endemic area of China[J].Carcinogenesis, 2013, 34 (8) :1800-1805.

[68]CHEN JG, EGNER PA, NG D, et al.Reduced aflatoxin exposure presages decline in liver cancer mortality in an endemic region of china[J].Cancer Prev Res (Phila) , 2013, 6 (10) :1038-1045.

[69]WANG JS, SHEN X, HE X, et al.Protective alterations in phase 1and 2 metabolism of aflatoxin B1 by oltipraz in residents of Qidong, People's Republic of China[J].J Natl Cancer Inst, 1999, 91 (4) :347-354.

[70]EGNER PA, WANG JB, ZHU YR, et al.Chlorophyllin intervention reduces aflatoxin-DNA adducts in individuals at high risk for liver cancer[J].Proc Natl Acad Sci U S A, 2001, 98 (25) :14601-14606.

[71]KENSLER TW, QIAN GS, CHEN JG, et al.Translational strategies for cancer prevention in liver[J].Nat Rev Cancer, 2003, 3 (5) :321-329.

[72]KENSLER TW, ROEBUCK BD, WOGAN GN, et al.Aflatoxin:A50-year odyssey of mechanistic and translational toxicology[J].Toxicol Sci, 2011, 120 (Suppl 1) :s28-s48.

[73]UENO Y, NAGATA S, TSUTSUMI T, et al.Detection of microcystins, a blue-green algal hepatotoxin, in drinking water sampled in Haimen and Fusui, endemic areas of primary liver cancer in China, by highly sensitive immunoassay[J].Carcinogenesis, 1996, 17 (6) :1317-1321.

[74]ZHENG C, ZENG H, LIN H, et al.Serum microcystin levels positively linked with risk of hepatocellular carcinoma:A case-control study in southwest China[J].Hepatology, 2017, 66 (5) :1519-1528.

[75]LEE YC, COHET C, YANG YC, et al.Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer[J].Int J Epidemiol, 2009, 38 (6) :1497-1511.

[76]CHUANG SC, LEE YC, HASHIBE M, et al.Interaction between cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer:A meta-analysis[J].Cancer Epidemiol Biomarkers Prev, 2010, 19 (5) :1261-1268.

[77]LIU X, BAECKER A, WU M, et al.Interaction between tobacco smoking and hepatitis B virus infection on the risk of liver cancer in a Chinese population[J].Int J Cancer, 2018, 142 (8) :1560-1567.

[78]CHUANG SC, LEE YC, WU GJ, et al.Alcohol consumption and liver cancer risk:A meta-analysis[J].Cancer Causes Control, 2015, 26 (9) :1205-1231.

[79]CHEN Y, WANG X, WANG J, et al.Excess body weight and the risk of primary liver cancer:An updated meta-analysis of prospective studies[J].Eur J Cancer, 2012, 48 (14) :2137-2145.

[80]YAO KF, MA M, DING GY, et al.Meta-analysis reveals gender difference in the association of liver cancer incidence and excess BMI[J].Oncotarget, 2017, 8 (42) :72959-72971.

[81]YANG WS, SHU XO, GAO J, et al.Prospective evaluation of type2 diabetes mellitus on the risk of primary liver cancer in Chinese men and women[J].Ann Oncol, 2013, 24 (6) :1679-1685.

[82]FENG X, WANG G, LI N, et al.The association between fasting blood glucose and the risk of primary liver cancer in Chinese males:A population-based prospective study[J].Br J Cancer, 2017, 117 (9) :1405-1411.

[83]PAN XF, HE M, YU C, et al.Type 2 diabetes and risk of incident cancer in China:A prospective study among 0.5 million Chinese adults[J].Am J Epidemiol, 2018, 187 (7) :1380-1391.

[84]ZHANG W, XIANG YB, LI HL, et al.Vegetable-based dietary pattern and liver cancer risk:Results from the Shanghai women's and men's health studies[J].Cancer Sci, 2013, 104 (10) :1353-1361.

[85]ZHANG W, SHU XO, LI H, et al.Vitamin intake and liver cancer risk:A report from two cohort studies in China[J].J Natl Cancer Inst, 2012, 104 (15) :1173-1181.

[86]MA X, YANG Y, LI HL, et al.Dietary trace element intake and liver cancer risk:Results from two population-based cohorts in China[J].Int J Cancer, 2017, 140 (5) :1050-1059.

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