Hepatitis B-related hepatocellular carcinoma: surveillance strategy directed by immune-epidemiology

Abstract

Hepatitis B infection (HBV) is one of the most common causes of hepatocellular carcinoma (HCC) worldwide. The age of occurrence, prognosis and incidence vary dramatically depending on the region of the world. This geographic variation is largely dependent on the contrasting incidence of HBV, age of transmission of the virus, the timing of integration into the human genome, and different HBV genotypes, as well as environmental factors. It results in a wide difference in viral interaction with the immune system, genomic modulation and the consequent development of HCC in an individual. In this review, we describe many factors implicated in HCC development, provide insight regarding at-risk populations and explain societal recommendations for HCC surveillance in persons living with HBV in different continents of the world.

A Case of Infiltrative Hepatocellular Carcinoma With Vascular Invasion Into the Heart

“…Our patient represents a late diagnosis of HCC which typically limits the treatment options to palliative therapy and end-of-life comfort cares. Commencement of HBV therapy in the appropriate individuals reduces the risk of HCC but does not eliminate this risk completely [ 8 ]. Early and prompt screening is vital to ensure early diagnosis of HCC and potential for curative treatment [ 8 , 9 ].…”

“…Commencement of HBV therapy in the appropriate individuals reduces the risk of HCC but does not eliminate this risk completely [ 8 ]. Early and prompt screening is vital to ensure early diagnosis of HCC and potential for curative treatment [ 8 , 9 ]. Furthermore, invasive HCC diagnosed in his 50s suggests an early onset of disease.…”

Recurrent HBV Integration Targets as Potential Drivers in Hepatocellular Carcinoma

“…4 Cohorts of HBsAg (−)/occult (+) and HBsAg (+) HCC patients. 5 HBV capture sequencing of a single occult HBV infection (OBI) patient. 6 Five of the thirty HCC tissues were analyzed by HBV-targeted NGS.…”

“…Current HBV–HCC screening guidelines vary regionally: the American Association for the Study of Liver Disease (AASLD), Canadian Association for the Study of the Liver (CASL), European Association for the Study of the Liver (EASL), Asian-Pacific Association for the Study of the Liver (APASL), and Latin-American Association for the Study of the Liver (ALEH) all have distinctive recommendations. Irrespective of the region, ultrasound with or without serum AFP screening is recommended every 6 months in HBV populations with risk factors that may include being of Asian descent, >40 years of age, cirrhosis, and PAGE-B score [ 5 ].…”

“…In this study, we collected integration sites identified in HCC tumor tissue and defined RTGs. A total of 18,596 HBV integration sites, detected using PCR- and NGS-based approaches [ 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], were analyzed. By characterizing the most frequent RTGs, we demonstrate the potential of identifying HCC drivers for HCC precision medicine and drug development.…”