Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis.
Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis.
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DOI：
10.1053/j.gastro.2018.01.064
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发表时间：
2018-05
期刊：
影响因子：
29.4
通讯作者：
Singal AG
中科院分区：
文献类型：
--
作者：
Tzartzeva K;Obi J;Rich NE;Parikh ND;Marrero JA;Yopp A;Waljee AK;Singal AG
学会指南在监测肝硬变患者早期肝细胞癌(HCC)方面的建议有所不同。我们比较了在有或没有甲胎蛋白(AFP)的情况下，监测成像在早期检测肝硬变患者中的表现。两位评价者从1990年1月到2016年8月对MEDLINE和Scope us进行了搜索，以确定已发表的全面和早期检测肝细胞癌的监测策略的敏感性和特异性。对于随机效应模型，使用德西蒙尼和莱尔德方法计算和比较了合并估计。这项研究是根据系统审查和荟萃分析指南的首选报告项目进行的。32项研究(包括13367名患者)表征了有或无甲胎蛋白测量的成像对检测肝硬变患者肝细胞癌的敏感性。超声诊断任何一期肝癌的敏感性为84%(95%CI，76%~92%)，而早期肝癌的敏感性仅为47%(95%CI，33%~61%)。在比较超声和未检测AFP的研究中，超声检测出敏感性低于超声加AFP检测的任何一期肝癌(相对风险[RR]，0.88；95%CI，0.83~0.93)，以及早期肝癌的敏感性低于超声加AFP检测的敏感性(RR，0.81；95%CI，0.71~0.93)。然而，超声单独检测肝癌的特异性高于超声加AFP检测(RR，1.08；95%CI，1.05-1.09)。超声诊断早期肝癌的敏感性分别为63%(95%CI，48%~75%)和45%(95%CI，30%~62%)(P=0.002)。只有4项研究评估了计算机断层扫描或基于磁共振图像的监测，它们对肝癌的诊断灵敏度为84%(95%可信区间为70%-92%)。在一项关于文献的荟萃分析中，我们发现在肝硬变患者中，单独使用超声检测早期肝癌的敏感性较低。在超声分析中加入甲胎蛋白显著提高了临床上检测肝癌的灵敏度。
Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Thirty-two studies (comprising 13367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% CI, 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI, 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR], 0.88; 95% CI, 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR, 0.81; 95% CI, 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR, 1.08; 95% CI, 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI, 48%–75%) and 45% sensitivity (95% CI, 30%–62%), respectively (P=.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI, 70%–92%). In a meta-analysis of publications, we found ultrasound alone to detect early-stage HCC with a low level of sensitivity in patients with cirrhosis. Addition of AFP to ultrasound analysis significantly increases the sensitivity of HCC detection in clinical practice.
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