摘要
肝細胞癌（以下簡稱肝癌）是全球排名第五位的癌症，全球肝癌患者約75%集中於亞洲地區。肝癌相關的危險因子主要包括B型肝炎病毒、C型肝炎病毒、、肝硬化、喝酒、抽菸、黃麴毒素、肥胖和男性等。其中慢性B、C型肝炎是肝癌最主要的危險因子。最新的研究顯示B肝帶原者罹患肝癌的病毒因子包括病毒基因型、血清病毒量、病毒基因體的變異等。病毒基因型C、基礎期血清病毒量高者、病毒基因體核心啟動子突變(basal core promoter mutation)及pre-S基因缺失突變(pre-S deletion mutation)者罹患肝癌的風險較高。台灣肝癌的另一主要原因為C型肝炎病毒，C肝帶原者罹患肝癌的相對危險性約為陰性者的35倍，其肝癌年發生率約1-4%。防治肝癌的主要方法為預防B、C型肝炎病毒的感染和黃麴毒素的汙染（初級預防），以及對於已受感染的慢性B、C型肝炎患者提供有效的抗病毒治療，減少患者進展至肝硬化和肝癌的風險（次級預防）。台灣新生兒全面施打B型肝炎疫苗有效減少兒童B肝帶原率及肝癌發生率。實證醫學分析結果證實，目前已發展的抗病毒治療確能減少慢性B和C型肝炎患者罹患肝癌的風險。B肝疫苗注射雖然成功的降低B肝帶原率，然而C型肝炎盛行率的增加導致全球肝癌發生率仍有上升的趨勢。因此預防C型肝炎病毒感染，並發展更有效的抗病毒治療，將是全球肝癌防治的重要課題。
並列摘要
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. More than 75% of HCC cases occur in the Far East and Southeast Asia. The risk factors associated with the development of HCC include chronic infection with either hepatitis B virus (HBV) or hepatitis C virus (HCV), the presence of cirrhosis, carcinogen exposure especially aflatoxin, cigarette smoking, alcohol abuse, obesity, and male gender. Among these risk factors, chronic hepatitis viral infections, particularly those with cirrhosis, show the strongest association with the development of HCC. Recently, several HBV viral factors including HBV genotype, viral load, HBV genome mutations have been reported to be associated with development of HCC. In summary, genotype C, high baseline serum HBV DNA level, basal core promoter T1762/A1764 mutation and pre-S deletion mutation are significantly associated with the development of HCC. HCV is the next most common cause of HCC in Taiwan. The odd ratio was estimated as 35. In patients with chronic hepatitis C, there is an increased risk of HCC with yearly incidence between 1-4%. The most effective tool to prevent the occurrence of HCC are avoiding HBV and HCV infection and control of contaminated crops (primary prevention), and by the use of effective antiviral agents to halt the progression from chronic hepatitis to cirrhosis and eventually HCC (secondary prevention). Universal hepatitis B vaccination program in Taiwan has reduced HBV carrier rate as well as HCC incidence in children. According to evidence from meta-analysis, current antiviral therapy can reduce overall risk of HCC development in patients with chronic hepatitis B or C. Although immunization has been successful against HBV, a changing disease burden of HCC has been observed in both developing and developed countries because of the increasing prevalence of HCV infection worldwide. Thus, future efforts to prevent HCV infection as well as the development of more effective treatment for chronic viral hepatitis are urgently needed to achieve the goal of global HCC control.