本文係探討近十年的文獻以瞭解肝細胞癌的流行病學特徵和危險因子。肝細胞癌的死亡率與發生率均隨年齡的增加而上升，但是不同地區的高峰年齡並不相同。男性的肝細胞癌在各國都是較女性偏高，性比例在2-4倍。肝細胞癌的發生率有明顯的地理差異，最高的發生率在東南亞和南部非洲。移民研究一致指出在新加坡、舊金山、洛杉機和夏威夷的中國人，其肝細胞癌發生率達高於其他種族。雖然近年來香港的肝癌死亡率維持不變而新加坡則呈下降；但在台灣和日本的肝癌死亡率，在男性有明顯增加，女性則未有明顯變化。B型肝炎病毒和C型肝炎病毒都和肝細胞癌的發生有密切相關。B型肝炎慢性帶原狀態是很多國家的主要肝細胞癌病因。C型肝炎病毒和肝細胞癌的困果相關，有待進一步研究的佐證，特別是世代追蹤研究的證據尤其重要。雖然黃麴毒素己證實是動物的肝臟致癌物，但它對人體的作用，因個人暴露量的測量方法有待改進，至今仍無定論。在中國和南部非洲的肝細胞癌組織，有p53基因249譯碼子的G→T突變，暗示黃麴毒素可能是該地區的肝細胞癌的致因，喝酒已被認定是人類肝細胞癌的重要危險因子，但是抽煙對肝細胞癌的作用，仍需繼續評估。肝硬化也在肝細胞癌的發生扮演重要角色。至於性荷爾蒙、微量營養素、遺傳疾病、糖尿病、人類白血球抗原等因素和肝細胞癌的相關性，有待進一步證實。最近的研究則指出B型肝炎病毒、C型肝炎病毒、喝酒、抽煙及家族肝癌史之間，有明顯的協同交互作用。

Researsh on the epidemiologic characteristics and risk factors of hepatocellular carcinoma (HCC) in the recent decade were reviewed in detail. HCC mortality and incidence increase with age in most countries, but a striking discrepancy in peak age is observed in different areas. The HCC incidence is higher for men than for women with a male-to-female ratio of greater than 2.0 in almost all countries. There is significant geographical variation in HCC incidence with the highest occurring in southeastern Asia and southern Africa. Migrant studies show that the Chinese have a higher incidence than other ethnic groups in Singapore, San Francisco, Los Angeles and Hawaii. While HCC mortality remains constant in Hong Kong and slightly declines in Singapore, an increasing secular trend of HCC mortality is reported for males but not for females in Taiwan and Japan. Both hepatitis B virus (HBV) and hepatitis C virus (HCV) are associated with the development of HCC. Chronic HBV infection is a major cause of HCC in many countries. More epidemiological evidence especially those from cohort studies are needed to conclude whether HCV is a cause of HCC. Although aflatoxins are well documented animal hepatocarcinogens, their effects on humans are still inconclusive due to inadequacy in quantitation of individual aflatoxin exposure. A specific G → T transversion on the third base of the p53 gene codon 249 recently found in HCC tissues from China and southern Africa suggests the importance of aflatoxin in the development of HCC. While alcohol drinking is an important risk factor in human HCC, the effect of cigarette smoking on HCC needs further assessment. Liver cirrhosis also plays a significant role in the development of HCC. The associations of HCC with sex hormones, micronutrients, genetic diseases, diabetes, and human leukocyte antigens have to be further validated. Synergistic interactions have recently been documented for HBV, HCV, alcohol drinking, cigarette smoking and a familial history of HCC.

Epidemiology, Risk Factors, Hepatocellular Carcinoma, etiology