Table 1.
Approaches to HCC Prevention
| Disease etiology | Type of prevention |
|||
|---|---|---|---|---|
| Primary | Secondary | Tertiary (targeting “early” recurrence) | Tertiary (targeting “late” recurrence) | |
| Hepatitis B virus | Universal vaccination | Blood screening, HCC surveillance | Cytotoxic drug? | Antiviral therapy (interferon, nucreos(t)ide analogs) |
| Prevention of new infection | Antiviral therapy (interferon, nucreos(t)ide analogs) | Transarterial embolization? | ||
| (Screening of blood products, safe injection practice) | Antiinflammatory/cytoprotective therapy (glycyrrhizin, UDCA)? Antifibrosis therapy? Acyclic retinoid? Vitamin K2? | Molecular targeted drug (gefitinib)? Immune modulator (sirolimus?, thymopentin?, adoptive immunothepaty?, HCC vaccination?) | Antiinflammatory/cytoprotective therapy (glycyrrhizin, UDCA)? Antifibrosis therapy? Acyclic retinoid? Vitamin K2? | |
| Hepatitis C virus | Prevention of new infection | Blood screening, HCC surveillance | Same as above | Antiviral therapy (interferon, interferon + ribavirion?) |
| (Screening of blood products, safe injection practice) | Antiviral therapy (interferon, interfron + ribavirion?) Antiinflammatory/cytoprotective therapy (glycyrrhizin, UDCA)? Antifibrosis therapy? Iron depletion? Acyclic retinoid? Vitamin K2? S-adenosylmethionine (SAMe)? | Antiinflammatory/cytoprotective therapy (glycyrrhizin, UDCA)? Antifibrosis therapy? Iron depletion? Acyclic retinoid? Vitamin K2? S-adenosylmethionine (SAMe)? | ||
| Dietary carcinogens (mainly aflatoxin B1) | Reduction of food/water pollution (establishment of water and sanitation infrastructure) | Antioxidant, inducer of cytoprotective enzymes (chlorophyllin?, oltipraz?, 3H1,2-dithiole-3-thione?) | Same as above | Antioxidant, inducer of cytoprotective enzymes (chlorophyllin?, oltipraz?, 3H1,2-dithiole-3-thione?) |
| Alcohol | Prevention of alcohol dependence/abuse | Abstinence of alcohol intake (not effective in cirrhosis?) Correction of nutritional deficiencies | Same as above | Abstinence of alcohol intake (not effective in cirrhosis?) Correction of nutritional deficiencies |
| Non-alcoholic metabolic disorders | Education on diet and physical activity | Life style/diet modification | Same as above | Life style/diet modification |
| (non-alcoholic fatty liver disease, obesity, type 2 diabetes) | Policy for healthy diet | Weight loss (diet, aerobic exercise) Control of diabetes Cytoprotective drug (UDCA?) | Weight loss (diet, aerobic exercise) Control of diabetes Cytoprotective drug (UDCA?) | |
| Genetic hemochromatosis | Genetic screening for high risk population | Iron depletion | Same as above | Iron depletion |
| Excess dietary iron | Education on dietary/drinking habit | Modification of dietary/drinking habit | Same as above | Modification of dietary/drinking habit |
| Iron depletion | Iron depletion | |||
| Primary biliary cirrhosis | Cytoprotective drug (UDCA?) | Same as above | Cytoprotective drug (UDCA?) | |
| Autoimmune hepatitis | Corticosteroids, immunosuppressive drugs | Same as above | Corticosteroids, immunosuppressive drugs | |
HCC: hepatocellular carcinoma, UDCA: ursodeoxycholic acid
“Early” recurrence: dissemination of primary tumor cells, usually observed within 1~2 years after curative treatment.
“Late” recurrence: de novo multicentric hepatocarcinogenesis independent from completely removed primary tumor, usually observed more than 1~2 years after curative treatment.