HEPATOCELLULAR-CARCINOMA IN ITALIAN PATIENTS WITH CIRRHOSIS
HEPATOCELLULAR-CARCINOMA IN ITALIAN PATIENTS WITH CIRRHOSIS
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DOI：
10.1056/nejm199109053251002
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发表时间：
1991-09-05
影响因子：
158.5
通讯作者：
DIOGUARDI, N
中科院分区：
文献类型：
--
作者：
COLOMBO, M;DEFRANCHIS, R;DIOGUARDI, N
背景和方法。肝硬化患者被认为有患肝细胞癌的风险。风险的大小，这种疾病的自然史，以及在西方世界患者中检测潜在可治愈肿瘤的可能性都是未知的。为了解决这些问题，我们从1985年到1990年检查了447例意大利代偿性肝硬化患者（其中62%为病毒性肝硬化），每3到12个月进行一次血清甲胎蛋白测定和实时超声检查。在平均33个月（范围，1至48）的随访期间，30例患者（7%）在基线时发现了肝细胞癌，另有29例患者（417例基线无肿瘤患者中的7%）发现了肝细胞癌。在随访期间，血清甲胎蛋白水平持续升高的患者（42例甲胎蛋白水平升高的患者中有12例患有肿瘤）发生肝细胞癌的累积风险高于血清甲胎蛋白水平波动的患者（82例中有11例）或血清甲胎蛋白水平持续正常的患者（255例中有6例）。只有17名患者具有潜在的可手术肿瘤。在随访期间检测到的潜在可手术肿瘤的比例显著低于入组时的比例（29例中的4例vs. 30例中的13例，P = 0.027）。接受手术的12名患者的一年生存率为67%，肿瘤复发率为60%。5例拒绝手术的患者的结局无明显差异。在西方，与亚洲一样，肝硬化患者患肝细胞癌的风险很大，年发病率为3%。我们的筛查计划并没有明显提高潜在可治愈肿瘤的检出率。
Background and Methods. Patients with cirhosis of the liver are recognized as being at risk for hepatocellular carcinoma. The magnitude of the risk, the natural history of this disease, and the possibilities for detecting potentially curable tumors in patients in the Western world are unknown. To address these questions, we examined 447 Italian patients with well-compensated cirrhosis (which was of viral origin in 62 percent of them) from 1985 through 1990, performing serum alpha-fetoprotein assays and real-time ultrasonography every 3 to 12 months.Results. Hepatocellular carcinoma was found in 30 patients (7 percent) at base line and in another 29 patients (7 percent of 417 patients free of tumor at base line) during follow-up periods averaging 33 months (range, 1 to 48). The cumulative hazard of the development of hepatocellular carcinoma during follow-up was higher among patients with persistently elevated serum alpha-fetaprotein levels (12 with tumors among 42 with such levels) than among those with fluctuating levels (11 among 82) or those with consistently normal levels (6 among 255). Only 17 patients had potentially operable tumors. The proportion of potentially operable tumors among those detected during follow-up was significantly lower than the proportion at enrollment (4 of 29 vs. 13 of 30, P = 0.027). The survival at one year of the 12 patients who underwent surgery was 67 percent, and the tumor-recurrence rate was 60 percent. Outcome was not appreciably different for the five patients who refused surgery.Conclusions. In the West, as in Asia, patients with cirrhosis of the liver are at substantial risk for hepatocellular carcinoma, with a yearly incidence rate of 3 percent. Our screening program did not appreciably increase the rate of detection of potentially curable tumors.