Hepatocellular carcinoma (HCC) is one of the few cancers in which a
continued increase in incidence has been observed over recent years.
Globally, there are approximately 750,000 new cases of liver cancer
reported each year. Importantly, population-based studies show that HCC
ranks as the third leading cause of cancer-related deaths worldwide.
Also, a large proportion of HCC patients display symptoms of
intrahepatic metastases or postsurgical recurrence, with a five-year
survival rate of around only 30-40%.
Among the various pathogenic factors, HBV infection accounts for
about 60% of the total liver cancer in developing countries and around
23% of cases in developed countries. The persistent presence of HBV DNA
in the serum of infected individuals has been found to be a strong
indicator for the development of HCC.
In contrast to a majority of cancer types, such as breast, lung, and
prostate cancer in which a tumor emerges within a relatively healthy
tissue, the initiation of HCC, especially HBV-associated HCC, is
intimately associated with a chronically diseased liver tissue. The
HBV-initiated tumorigenic process often goes with or occurs secondary to
long-term symptoms of chronic hepatitis, inflammation and cirrhosis.
The HBV-associated tumor microenvironment forms a complex system in
which both cellular and subcellular components with reciprocal signaling
contribute critically to the carcinogenic progression.
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