Author response to Letter to the Editor: 'Chronological change in alpha-foetoprotein levels in hepatocellular carcinoma after eradication of hepatitis C virus'.
Author response to Letter to the Editor: 'Chronological change in alpha-foetoprotein levels in hepatocellular carcinoma after eradication of hepatitis C virus'.
复制标题
作者对给编辑的信的回应：“根除丙型肝炎病毒后肝细胞癌中甲胎蛋白水平的时间变化”。
DOI：
10.1111/liv.14612
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Parikh,NeeharD
中科院分区：
文献类型：
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作者：
Chen,VincentL;Parikh,NeeharD
致编辑，我们感谢福本博士和同事们与我们的手稿有关的信件。1、2丙型肝炎直接作用抗病毒(DAA)治疗后持续病毒学应答(SVR)的肝硬变患者，甲胎蛋白(AFP)检测肝细胞癌(HCC)的敏感性有限。3我们的研究不能直接解决在这一人群中将AFP纳入肝癌监测是否与改善预后相关，原因有两个。首先，在我们的队列中，AFP很少用于肝细胞癌的监测(至少与成像结合使用，因为我们没有考虑仅使用AFP的监测)，AFP和超声覆盖的时间比例中值为0%。其次，只有一小部分患者接受过DAA治疗，因为研究期间主要是在DAA之前的时代。需要注意的是，在丙型肝炎和SVR患者中的数据是有限的，我们相信证据的平衡支持将AFP纳入肝细胞癌监测。在最近的一项荟萃分析中，AFP联合超声对早期肝细胞癌的检测显示出比单独超声更高的敏感性(63%比45%)。4纵向AFP测定可进一步提高对肝细胞癌诊断的敏感性。5还需要进一步的研究，以确定超声在接受DAA治疗的SVR后的丙型肝炎肝硬变患者中使用或不使用AFP的敏感性和特异性，以确定在这一人群中将AFP纳入肝细胞癌监测的益处。
To the Editor, We thank Dr Fukumoto and colleagues for their letter related to our manuscript. 1, 2 There are limited data on sensitivity of alpha-foetoprotein (AFP) for hepatocellular carcinoma (HCC) detection in patients with cirrhosis who achieved sustained virologic response (SVR) after direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection. 3 Our study was not able to directly address whether including AFP in HCC surveillance in this population is associated with improved outcomes, for two reasons. First, in our cohort, AFP was infrequently used for HCC surveillance (at least in conjunction with imaging, as we did not consider AFP-only surveillance) with median proportion of time covered by both AFP and ultrasound of 0%. Second, only a small proportion of patients had received DAA therapy as the study period was largely in the pre-DAA era. With the caveat that data are limited in patients with HCV and SVR, we believe that the balance of evidence favours inclusion of AFP in HCC surveillance. In a recent meta-analysis, AFP plus ultrasound demonstrated higher sensitivity than ultrasound alone for early-stage HCC detection (63% vs 45%). 4 Longitudinal AFP measurement may further increase sensitivity for HCC detection. 5 Further studies are required to establish sensitivity and specificity of ultrasound with or without AFP in patients with HCV cirrhosis after SVR with DAA therapy, to determine the benefits of incorporating AFP into HCC surveillance in this population.