No Association Between Screening for Hepatocellular Carcinoma and Reduced Cancer-Related Mortality in Patients With Cirrhosis.
No Association Between Screening for Hepatocellular Carcinoma and Reduced Cancer-Related Mortality in Patients With Cirrhosis.
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肝硬化患者的肝细胞癌筛查与癌症相关的死亡率降低之间没有关联。
DOI：
10.1053/j.gastro.2018.06.079
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发表时间：
2018-10
期刊：
影响因子：
29.4
通讯作者：
Ioannou GN
中科院分区：
文献类型：
--
作者：
Moon AM;Weiss NS;Beste LA;Su F;Ho SB;Jin GY;Lowy E;Berry K;Ioannou GN
已推荐对肝硬化患者进行肝细胞癌（HCC）筛查。我们在美国退伍军人事务（VA）医疗保健系统内进行了一项匹配病例对照研究，以确定通过腹部超声（USS）和/或测量血清甲胎蛋白（AFP）水平进行筛查是否与肝硬化患者癌症相关死亡率降低有关。
我们将病例（n = 238）定义为在2013年1月1日至2015年8月31日期间死于HCC且在被诊断为HCC之前已在VA接受肝硬化诊断≥4年的肝硬化患者。我们为每个病例匹配1名对照（n = 238），对照定义为未死于HCC且在与其匹配病例被诊断为HCC之日前已在VA接受治疗≥4年的肝硬化患者。对照通过肝硬化诊断年份、种族/族裔、年龄、性别、肝硬化病因、MELD评分和VA医疗中心与病例进行匹配。我们确定了病例在被诊断为HCC之日前4年内或对照在相应索引日期前进行的所有USS和血清AFP检测，并通过病历提取（对病例或对照状态设盲）确定这些检测是否是为筛查而进行的。
在索引日期前4年内，接受筛查性USS的患者比例（52.9%对54.2%）、血清AFP筛查性测量的患者比例（74.8%对73.5%）、进行筛查性USS或血清AFP测量的患者比例（81.1%对79.4%），或两者都进行的患者比例（46.6%对48.3%），在病例和对照之间无显著差异，无论是否对潜在混杂因素进行调整。在索引日期前1年、2年或3年内接受这些筛查检测的情况也无差异。
在对VA医疗保健系统进行的一项匹配病例对照研究中，我们发现通过USS、血清AFP测量、任一检测或两者对肝硬化患者进行HCC筛查与HCC相关死亡率降低无关。我们鼓励进行更多的病例对照研究，以评估在其他医疗保健系统中进行HCC筛查的有效性，在这些系统中，现有记录足够详细，能够确定USS和AFP检测的适应证。
Screening patients with cirrhosis for hepatocellular carcinoma (HCC) has been recommended. We conducted a matched case–control study within the US Veterans Affairs (VA) healthcare system to determine whether screening by abdominal ultrasonography (USS) and/or by measuring serum level of alpha fetoprotein (AFP) is associated with reduced cancer-related mortality in patients with cirrhosis. We defined cases (n=238) as patients with cirrhosis who died of HCC from January 1, 2013 through August 31, 2015 and had been in VA care with a diagnosis of cirrhosis for ≥4 years prior to the diagnosis of HCC. We matched each case to 1 control (n=238), defined as a patient with cirrhosis who did not die of HCC and had been in VA care for ≥4 years prior to the date of his matched case’s HCC diagnosis. Controls were matched to cases by year of cirrhosis diagnosis, race/ethnicity, age, sex, etiology of cirrhosis, MELD score, and VA medical center. We identified all USS and serum AFP tests performed within 4 years before the date of HCC diagnosis in cases or the equivalent index date in controls, and determined via chart extraction (blinded to case or control status) whether these tests were performed for screening. There were no significant differences between cases and controls in the proportions of patients who underwent screening USS (52.9% vs 54.2%), screening measurement of serum AFP (74.8% vs 73.5%), either a screening USS or measurement of serum AFP (81.1% vs 79.4%), or both (46.6% vs 48.3%) within 4 years before the index date, with or without adjusting for potential confounders. There was also no difference in receipt of these screening tests within 1, 2, or 3 years prior to the index date. In a matched case–control study of the VA healthcare system, we found that screening patients with cirrhosis for HCC by USS, measurement of serum AFP, either test, or both was not associated with decreased HCC-related mortality. We encourage additional case–control studies to evaluate the efficacy of screening for HCC in other healthcare systems, in which available records are sufficiently detailed to enable identification of the indication for USS and AFP tests.
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