Zusammenfassung
Die durch die Hepatitis-Viren B (HBV) und C (HCV) induzierte Leberzirrhose stellt den Hauptrisikofaktor für die Entwicklung eines hepatozellulären Karzinoms (HCC) dar. Die Prävention der chronischen Hepatitis-Virus-Infektion bzw. der Entstehung einer Leberzirrhose hat daher zentrale Bedeutung für die Primärprävention des HCC. Durch eine konsequente Impfung gegen HBV kann die Rate der HBV-Infektionen signifikant reduziert und die HCC-assoziierte Mortalität gesenkt werden. Wegen des Fehlens eines Impfstoffes gegen HCV müssen sich die Bemühungen zur Primärprävention der HCV-Infektion auf die Reduktion risikoreicher Verhaltensweisen und die Verbesserung hygienischer Bedingungen beschränken. Im präzirrhotischen Stadium einer chronischen HBV- oder HCV-Infektion kann durch eine effektive antivirale Therapie mit dem Ziel eines dauerhaften virologischen Ansprechens die Entwicklung einer Zirrhose bzw. eines HCC wirkungsvoll verhindert werden. Bei Patienten mit bereits bestehender Zirrhose bleibt jedoch selbst bei anhaltender virologischer Remission nach antiviraler Therapie das Risiko für die HCC-Entwicklung erhöht und erfordert weiterhin ein regelmäßiges Screening zur HCC-Früherkennung. Inwiefern virologische Nonresponder hinsichtlich der HCC-Entwicklung von einer antiviralen Dauertherapie profitieren, kann noch nicht sicher beurteilt werden. Die Frühdiagnose der chronischen HBV- und HCV-Infektion stellt daher den entscheidenden Faktor bei der Prävention des HCC dar. Eine Sekundärprävention nach kurativer Resektion bzw. lokal ablativer Therapie durch eine antivirale Therapie scheint die Rate später Rezidive zu senken. Die Lebertransplantation stellt heutzutage die wirksamste sekundär präventive Strategie für ausgewählte Patienten mit HCC dar. Im Anschluss an eine Lebertransplantation spielt das Immunsuppressivum Sirolimus aufgrund seiner zusätzlichen antiproliferativen Eigenschaften möglicherweise eine Rolle in der Sekundärprävention des HCC.
Abstract
Liver cirrhosis induced by HBV and HCV infections is the main risk factor for the development of hepatocellular carcinoma (HCC). Therefore, prevention of chronic infection with hepatitis viruses and prevention of the development of cirrhosis are essential for the primary prevention of HCC. A consequent vaccination program for HBV is suitable to reduce the rate of infections and the HCC-associated mortality. Since no vaccine is available for HCV, the reduction of risky behaviour and the improvement of hygiene standards are the mainstays for prevention of HCV. An efficient antiviral therapy aimed at the durable suppression of the viral load reduces the risk of progression to cirrhosis and development of HCC in precirrhotic stages of chronic HBV or HCV infections. In cirrhotic patients, the risk of developing HCC remains elevated even if a sustained virological response is achieved, thus requiring further screening with the intention of the early detection of HCC. It is too early to judge whether virological nonresponders profit from continued antiviral therapy. Therefore, the early diagnosis of chronic HBV or HCV infection is the single most important factor for the prevention of HCC. Secondary prevention after surgical resection or local ablative therapy may reduce the frequency of late recurrence. Liver transplantation is today the most effective measure of secondary prevention for selected patients with HCC. Due to its antiproliferative effects, the immunosuppressive drug sirolimus may play a role for secondary prevention of HCC following transplantation.
Schlüsselwörter
Leber - Virushepatitis - Hepatitis B - Hepatitis C
Key words
liver - viral hepatitis - hepatitis B - hepatitis C
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Dr. Eckart Schott
Med. Klinik m. S. Hepatologie und Gastroenterologie, Charité, CVK
Augustenburger Platz 1
13353 Berlin
Phone: ++ 49/30/4 50 55 30 71
Fax: ++ 49/30/4 50 55 39 03
Email: eckart.schott@charite.de
