Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 28, 2015; 7(12): 1708-1717
Published online Jun 28, 2015. doi: 10.4254/wjh.v7.i12.1708
Hepatocellular carcinoma in Asia: Prevention strategy and planning
Sara Ashtari, Mohamad Amin Pourhoseingholi, Afsaneh Sharifian, Mohamad Reza Zali
Sara Ashtari, Mohamad Amin Pourhoseingholi, Afsaneh Sharifian, Mohamad Reza Zali, Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran
Author contributions: Sharifian A and Zali MR designed the research; Pourhoseingholi MA designed and checked an edited the paper as a correspondence; Ashtari S performed the research and write the paper.
Supported by Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences.
Conflict-of-interest: The authors declared do not have anything to disclose regarding funding of conflict-of-interest with respect to this manuscript.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mohamad Amin Pourhoseingholi, PhD, Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tabnak St, Yaman Ave, Velenjak, Tehran 1985717413, Iran. amin_phg@yahoo.com
Telephone: +98-21-22432515 Fax: +98-21-22432517
Received: September 17, 2014
Peer-review started: September 20, 2014
First decision: November 27, 2014
Revised: December 31, 2014
Accepted: May 26, 2015
Article in press: May 27, 2015
Published online: June 28, 2015
Processing time: 284 Days and 22.7 Hours
Abstract

AIM: To review all of epidemiological and etiological aspects of hepatocellular carcinoma (HCC) and examined the prevention of this disease in Asia.

METHODS: We conducted a systematic review according to the PRISMA guidelines. We were chosen articles that published previously, from PubMed (MEDLINE), the Cochrane database and Scopus. The key words used in this research were as follows: HCC in Asia and the way of prevention of this disease, with no language limitations. We selected those papers published before 2014 that we considered to be most important and appropriate. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.

RESULTS: More than 70% of all new cases of liver cancer were diagnosed in Asia, a region that 75% of all those chronically infected with hepatitis B virus (HBV) in the world. Chronic HBV infection is the main cause of HCC in Asia, where the virus is endemic and vertical transmission is common. Japan, Saudi Arabia, Egypt and Pakistan are exception because of high prevalence of HCV infection in these regions. The prevalence of this cancer is high in Eastern and South-Eastern Asia, But Middle Eastern countries are characterized as moderate prevalence rate of HCC region and Central Asia and some part of Middle Eastern countries are known as low prevalence rate of HCC. In addition of HBV and HCV the other factors such as aflatoxin, alcohol, obesity, diabetes and non-alcoholic fatty liver disease (NAFLD) might be responsible for a low prevalence of HCC in Asian countries. Currently available HCC therapies, chemotherapy, surgical are inefficient, mainly due to usually late diagnosis and high recurrence rates after surgical resection, and usually end with treatment failure. Liver transplantation also remains as a difficult strategy in patients with HCC. Thus prevention of HCC by treating and prevention HBV and HCV infection, the major causative agents of HCC, and the other risk factors such as aflatoxin, alcohol, obesity, diabetes and NAFLD is of a great medical importance.

CONCLUSION: The main challenge which still present in Asia, is the high prevalence of chronic hepatitis. So, prevention of HBV and HCV is the key strategy to reduce the incidence of HCC in Asia.

Keywords: Hepatocellular carcinoma; Viral hepatitis; Prevention strategy; Asian countries

Core tip: In this current review, the burden and incidence of hepatocellular carcinoma (HCC) in Asian countries, risk factors and prevention of HCC are discussed. Infection of hepatitis B virus (HBV) is the main cause of HCC in Asia continent, where the virus is endemic and vertical transmission is common. Japan, Saudi Arabia, Egypt and Pakistan are exception due to of high prevalence of HCV infection. The main challenge which still present in Asia, is the high prevalence of chronic hepatitis. So, HBV and HCV prevention is the key strategy to decrease the incidence and burden of HCC in Asia.