Recently, metabolic associated steatotic liver disease (MASLD) became the leading cause of chronic liver disease worldwide and one of the most frequent causes of hepatocellular carcinoma (HCC). Nonetheless, in this epidemiological trend, viral hepatitis remains the major driver in hepatic carcinogenesis. Globally, hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma, with an overall attributable risk of approximately 40%, followed by hepatitis C virus (HCV), which accounts for 28–30% of cases, with significant geographic variations between the Eastern and Western world. Considering all the etiologies, HCC risk increases proportionally with the progression of liver disease, but the risk is consistently higher in patients with viral triggers. This evidence indicates that both direct (due to the oncogenic properties of the viruses) and indirect (through the mechanisms of chronic inflammation that lead to cirrhosis) mechanisms are involved, alongside the presence of co-factors contributing to liver damage (smoking, alcohol, and metabolic factors) that synergistically enhance the oncogenic process. The aim of this review is to analyze the oncogenic role of hepatitis viruses in the liver, evaluating epidemiological changes and direct and indirect viral mechanisms that lead to liver cancer.
近年来，代谢相关脂肪性肝病（MASLD）已成为全球慢性肝病的主要病因，也是肝细胞癌（HCC）最常见的诱因之一。然而，在此流行病学趋势中，病毒性肝炎仍是肝癌发生的主要驱动因素。在全球范围内，乙型肝炎病毒（HBV）是肝细胞癌的首要致病因素，总体归因风险约为40%；其次为丙型肝炎病毒（HCV），约占病例总数的28%-30%，且东西方地域差异显著。综合所有病因分析，肝癌风险随肝病进展呈比例上升，但病毒诱发患者的风险持续处于更高水平。这一证据表明，除协同促进肝脏损伤的辅助因素（吸烟、酒精及代谢因素）能协同增强致癌进程外，病毒既通过直接致癌机制（源于病毒的致癌特性），也通过间接途径（经由导致肝硬化的慢性炎症机制）参与肝癌发生。本综述旨在解析肝炎病毒在肝脏中的致癌作用，评估流行病学变迁以及导致肝癌的直接与间接病毒作用机制。
The Role of Hepatitis Viruses as Drivers of Hepatocancerogenesis
肿瘤(癌症)患者之家