编者按：Patrizia Farci博士，美国国立卫生研究院（NIH）、国家过敏症及传染病研究所（NIAID）传染病实验室肝脏发病机制研究室主任，致力于研究急性和慢性病毒性肝炎的发病机制、自然史和治疗。“第三届中国国际肝病论坛”召开期间，Farci博士介绍了“丙型肝炎病毒感染相关肝癌的研究进展”，并于会后就此话题接受了《国际肝病》的采访。

 

　　《国际肝病》：全球范围内，HCV相关性肝细胞肝癌（HCC）的流行病学如何?

 

　　Patrizia Farci 教授：我认为HCV相关HCC的流行情况发生了一些变化，如美国目前的HCC发生率有所增高。与已经达到峰值的意大利或日本相比，HCV相关HCC可能是导致（美国）癌症相关死亡率快速增高的原因。在美国，目前HCV相关HCC是肝移植最重要的原因，HCV感染同样也是HCC发生率升高的原因。

 

　　Prof. Farci: Thanks for asking me these questions. I believe that the epidemiology of HCV associated hepatocellular carcinoma worldwide shows some changes, for instance in the United States now there is an increasing incidence of hepatocellular carcinoma. It has become probably the fastest cause of cancer related deaths compared maybe to Italy or Japan where the peak has already been reached so it depends also per country. In the United States now it is the most important cause of liver transplantation and it is also the cause of an increasing rate of hepatocellular carcinoma with HCV infection.

 

　　《国际肝病》：清除HCV能够完全阻断肝硬化或无肝硬化患者HCC的风险吗？

 

　　Patrizia Farci 教授：首先需要区分患者是否合并肝硬化。在无肝硬化患者中，清除HCV将可能使患者完全康复，不仅表现为病毒的清除而且肝脏病理也获得恢复。在肝硬化患者，虽然有一些较好的研究结果，但是还需等待更多的数据来证实DAA治疗肝硬化患者的效果，及其对HCC进展风险的影响。到目前为止，我们还未获得所有数据，因此下结论还为时尚早。现有一些数据显示，一旦清除病毒后肝纤维化可获得改善，但是完全确定对肝硬化及HCC进展风险的影响，还需要掌握更多的数据才能准确地评价。

 

　　Prof. Farci: I think that we need to distinguish patients without cirrhosis and patients with cirrhosis. I believe that in patients without cirrhosis it will be very likely that the patient will recover completely, not only in terms of clearing the virus but also in terms of the liver pathology. In patients with cirrhosis there are some encouraging results but probably we need to wait a little bit more in order to establish the effect of the DAA treatment on patients with cirrhosis and the risk of developing hepatocellular carcinoma. We do not have all the data so far. I think it is too early. There are some encouraging data that once that you clear the virus there is an improvement in fibrosis but to fully determine how much the risk will decrease in patients with cirrhosis and the risk of developing hepatocellular carcinoma, I think we need to wait more and to have more data.

 

　　《国际肝病》：获得持续病毒学应答（SVR）患者发生HCC的风险因素有哪些？

 

　　Patrizia Farci 教授：对于已获得SVR的患者，有多种因素需要确定。如果没有肝硬化以及如酗酒的其他危险因素，发生HCC的可能性较低。然而，如果清除了病毒但患者存在肝硬化以及如NASH、糖尿病等其他疾病，HCC风险可能增高。如果病毒持续存在，发生HCC的风险较高。

 

　　Prof. Farci: This is a good question. I think that there are several factors for sure in patients that have a sustained virological response. If they are not cirrhotic and if they do not have other risk factors like abuse of alcohol or other factors, probably the chance of developing hepatocellular carcinoma is low. However if you clear the virus but the patient has cirrhosis and maybe other diseases like NASH or diabetes or other factors, I think it may increase regardless or not there is a presence of HCV even if they clear the virus but of course if you clear the virus and you do not have other risk factors, then I do not think the risk of developing hepatocellular carcinoma will be as high as if you have the virus.

 

　　《国际肝病》：如何对获得SVR的肝硬化患者进行HCC监测？

 

　　Patrizia Farci 教授：这是一个重要的问题。我们尚未获得数据来确定肝硬化患者清除病毒可以降低多少HCC发生风险。直到这方面数据清楚前，应当至少持续监测患者的临床表现，如果存在AFP升高，需要每6个月进行超声监测。这样对于肝硬化患者而言才更为合适。

 

　　Prof. Farci: This is an important question. I think we do not yet have the data to make sure how much this will decrease the risk of developing hepatocellular carcinoma in patients with cirrhosis that clear the virus. I believe that until this data is really clear we should continue to monitor the patients with at least, it depends on their clinical picture, if they have an alpha fetoprotein that is elevated then I think we need to monitor with an ultrasound every six months. This would make me I feel more comfortable in patients with cirrhosis.

 

　　《国际肝病》：在临床特征和转归方面，HCV相关性HCC患者与其他病因相关的HCC患者有什么差别吗？

 

　　Patrizia Farci 教授：当不幸罹患HCC时，除肿瘤体积必须很小时进行肝移植或手术切除外，目前并没有太多有效的治疗方法。基于不同病毒所致HCC并不存在临床转归方面的差异，尤其是目前已有较好的抗病毒治疗方法，根据我的经验，一旦患者发生HCC，其临床转归并不存在显著差异。

 

　　Prof. Farci: I think that whilst you have hepatocellular carcinoma unfortunately there are not very many effective treatments except the liver transplantation or resection but even then the tumor must be very small. I do not think there is so much difference in terms of the outcome according to the virus especially now that we have very good and important antivirals. I do not think that once a patient has hepatocellular carcinoma there is a significant difference in the outcome if you have hepatocellular carcinoma with HCV in my experience.

编辑：徐婷婷