Screening for hepatocellular carcinoma
Screening for hepatocellular carcinoma
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DOI：
10.1002/hep.510270140
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发表时间：
1998-01-01
期刊：
影响因子：
13.5
通讯作者：
Sherman, M
中科院分区：
文献类型：
--
作者：
Collier, J;Sherman, M
与某些其他癌症相比，至少在肝病学家中，肝癌 1-4 筛查已成为终末期肝病患者治疗中公认的一部分。然而，目前还没有针对肝细胞癌 (HCC) 筛查或监测的随机对照试验，也没有对成本、疗效和潜在收益进行充分的分析。本文的目的是批判性地探讨对肝病患者进行肝癌筛查的基本原理。根据定义，筛查是一次性应用一种测试，可以在干预可能显着改善自然病程和结果的阶段检测出疾病。 5 相反，监视是随着时间的推移重复应用此类测试。两者的目标都是降低特定疾病的死亡率。 Prorok5 阐明了判断任何筛查/监测计划的标准： 1) 该疾病必须很常见，并且具有很高的死亡率和发病率。 2) 目标人群必须易于识别，并且必须期望照顾该人群的医生会接受筛查的必要性，并且人群会响应筛查的号召。 3) 筛查试验必须具有低发病率和高敏感性和特异性。 4）必须有标准化的召回程序。 5) 筛选测试必须为目标人群所接受。 6) 最后，也是最重要的，必须有一种可接受且有效的治疗方法。在本文中，我们将根据这些标准检查 HCC，并将讨论针对 HCC 制定有效筛查/监测计划所面临的一些挑战。
In contrast to certain other cancers, 1-4 screening for liver cancer has become, at least among hepatologists, an accepted part of the management of patients with end-stage liver disease. Yet there have been no randomized, controlled trials of screening or surveillance for hepatocellular carcinoma (HCC), nor are there adequate analyses of cost, efficacy, and potential benefit. It is the intent of this article to critically examine the rationale for screening patients with liver disease for liver cancer.By definition, screening is the one-time application of a test that allows the detection of a disease at a stage when intervention may significantly improve the natural course and outcome. 5 In contrast, surveillance is the repeated application of such tests over time. The objective of both is to reduce disease-specific mortality. Prorok5 has enunciated the criteria by which any screening/surveillance program can be judged: 1) The disease must be common and have a substantial mortality and morbidity. 2) The target population must be easily identifiable, and there must be an expectation that the physicians caring for the population will accept that screening is necessary and that the population will answer the call for screening. 3) The screening test must have a low morbidity and a high sensitivity and specificity. 4) There must be standardized recall procedures. 5) The screening test must be acceptable to the target population. 6) Finally, and most importantly, there must be an acceptable and effective therapy. In this article, we will examine HCC in light of these criteria, and we will discuss some of the challenges to instituting effective screening/surveillance programs for HCC.