title: Hepatocellular carcinoma as an emerging morbidity in the thalassemia syndromes: A comprehensive review.
abstract: The incidence of hepatocellular carcinoma (HCC) in patients with thalassemia is on the rise. The 2 well recognized HCC risk factors in thalassemia are iron overload and chronic viral infection with hepatitis C. The carcinogenicity of iron is related to its induction of oxidative damage, which results in genotoxicity, and to immunologic dysregulation, which attenuates cancer immune surveillance. Chronic hepatitis B and C infections lead to necroinflammation, which can prompt progression to HCC, but an independent role of hepatitis B virus in hepatic carcinogenesis among patients with thalassemia has not been demonstrated. Screening patients who have thalassemia using magnetic resonance imaging-based liver iron concentration measurement and liver ultrasound is recommended for early detection of iron overload and HCC, respectively. Prevention primarily resides in hepatitis B vaccination, donor blood screening, hepatitis treatment, and iron chelation. Although solid data is lacking on the outcomes of HCC treatment in patients with thalassemia, a personalized approach tailored to the individual patient's comorbidities remains necessary for treatment success. Treatment modalities for HCC include surgical resection, chemoembolization, and liver transplantation, among others. Multicenter studies are needed to better explore therapeutic targets that can improve the prognosis of these patients. Cancer 2017;123:751-58. © 2016 American Cancer Society.
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Moukhadder
authors.affiliation: Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Racha
authors.initials: R
authors.lastname: Halawi
authors.affiliation: Department of Internal Medicine, Foundation of the Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Ca' Granda Ospedale Maggiore Polyclinic, Milan, Italy.|Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Maria Domenica
authors.initials: MD
authors.lastname: Cappellini
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ali T
authors.initials: AT
authors.lastname: Taher
mesh_terms: D063646:Carcinogenesis / Q000235:genetics; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016174:Hepacivirus / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D006801:Humans; D019190:Iron Overload / Q000000981:diagnostic imaging / Q000503:physiopathology; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012307:Risk Factors; D013789:Thalassemia / Q000150:complications / Q000503:physiopathology* / Q000821:virology
keywords: hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; iron overload; thalassemia