Hepatocellular Carcinoma Screening Is Associated With Increased Survival of Patients With Cirrhosis
Hepatocellular Carcinoma Screening Is Associated With Increased Survival of Patients With Cirrhosis
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DOI：
10.1016/j.cgh.2018.10.031
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发表时间：
2019-04-01
影响因子：
12.6
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
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作者：
Choi, Debra T.;Kum, Hye-Chung;Singal, Amit G.
背景与目的：肝硬化患者的肝细胞癌（HCC）筛查被专业协会推荐，以增加早期肿瘤的检测和生存率，但在临床实践中未得到充分利用。方法：我们对2003年至2013年诊断为HCC的13，714例患者进行了回顾性队列研究，纳入了监测，流行病学和最终结果计划-医疗保险数据库。我们使用互斥分类（一致vs不一致vs无筛查）和筛查覆盖时间比例来描述HCC诊断前3年内接受HCC筛查的特征。使用多变量2部分回归模型评估筛选接收的相关性。我们用多变量逻辑回归分析了筛查收据和肿瘤早期发现之间的关系。我们使用考克斯比例风险模型评估筛选接收和总生存率之间的关联，调整后的影响，提前时间偏差和长度时间偏差生存率estimators.RESULTS：大多数肝硬化患者（51.1%）没有接受任何筛选，在3年前诊断为肝癌，只有6.8%的患者进行了一致的年度筛选。接受一致筛查的比例从2003年至2006年的5.4%增加到2011年至2013年的8.8%（P < .001）。所涵盖时间的平均比例总体为13.4%，从2003年至2006年的11.7%增加到2011年至2013年的15.2%。接受一致的筛查与早期肿瘤的检出相关（比值比，1.98; 95%CI，1.68-2.33），校正前置时间偏倚后死亡风险降低（风险比，0.76; 95%CI，0.70-0.83）。不一致的筛查与HCC早期发现率的小幅增加（优势比，1.31; 95%CI，1.20-1.43）和死亡风险的降低（风险比，0.86; 95%CI，0.83-0.90）相关。校正导联和长度时间偏倚后，（23%; 95% CI，21%-25%）和筛选不一致（19%; 95% CI，19%-20%）与未进行筛选的患者相比，结论：在对监测、流行病学和最终结果计划-医疗保险数据库的分析中，我们发现肝硬化患者的HCC筛查未得到充分利用。这有助于在晚期检测肝脏肿瘤和缩短生存时间。然而，筛查HCC的患者比例随着时间的推移而增加。
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) screening of patients with cirrhosis is recommended by professional societies to increase detection of early stage tumors and survival, but is underused in clinical practice.METHODS: We conducted a retrospective cohort study of 13,714 patients diagnosed with HCC from 2003 through 2013 included in the Surveillance, Epidemiology, and End Results Program-Medicare database. We characterized receipt of HCC screening in the 3 years before HCC diagnosis using mutually exclusive categories (consistent vs inconsistent vs no screening) and the proportion of time covered with screening. Correlates for screening receipt were assessed using a multivariable 2-part regression model. We examined the association between screening receipt and early detection of tumors using multivariable logistic regression. We evaluated associations between screening receipt and overall survival using a Cox proportional hazards model, after adjustments for effects of lead-time bias and length-time bias on survival rate estimators.RESULTS: Most patients with cirrhosis (51.1%) did not receive any screening in the 3 years before a diagnosis of HCC, and only 6.8% of patients underwent consistent annual screening. The proportion with consistent screening increased from 5.4% in 2003 to 2006 to 8.8% in 2011 to 2013 (P < .001). The mean proportion of time covered was 13.4% overall, which increased from 11.7% in 2003 to 2006 to 15.2% in 2011 to 2013. Receipt of consistent screening was associated with detection of early stage tumors (odds ratio, 1.98; 95% CI, 1.68-2.33) and a reduced risk of death after correction for lead-time bias (hazard ratio, 0.76; 95% CI, 0.70-0.83). Inconsistent screening was associated with a slightly smaller increase in early detection of HCC (odds ratio, 1.31; 95% CI, 1.20-1.43) and a reduced risk of death (hazard ratio, 0.86; 95% CI, 0.83-0.90). After correction for lead- and length-time biases, higher proportions of patients with consistent (23%; 95% CI, 21%-25%) and inconsistent screening (19%; 95% CI, 19%-20%) survived for 3 years compared with patients without screening (13%; 95% CI, 12%-14%).CONCLUSIONS: In an analysis of the Surveillance, Epidemiology, and End Results Program-Medicare database, we found HCC screening to be underused for patients with cirrhosis. This contributes to detection of liver tumors at later stages and shorter times of survival. However, the proportion of patients screened for HCC has increased over time.