Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States.
Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States.
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DOI：
10.1002/hep.23615
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发表时间：
2010-07
期刊：
影响因子：
13.5
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
--
作者：
Davila, Jessica A.;Morgan, Robert O.;Richardson, Peter A.;Du, Xianglin L.;McGlynn, Katherine A.;El-Serag, Hashem B.
建议对肝硬化患者进行肝细胞癌（HCC）监测，但可能不进行。HCC监测的程度和决定因素尚不清楚。我们对65岁以上的人群进行了一项基于人群的美国队列研究，以检查既往诊断为肝硬化的HCC患者诊断前监测的利用率和决定因素。1994-2002年期间诊断为HCC的患者是从相关的监测、流行病学和最终结果登记-医疗保险数据库中确定的。我们确定了甲胎蛋白和超声检查用于HCC监测，并检查了与监测相关的因素。我们确定了1，873例既往诊断为肝硬化的HCC患者。在HCC发生前3年，17%的患者接受了定期监测，38%的患者接受了不一致的监测。在541例肝硬化患者中，只有29%的患者接受了常规监测，33%的患者接受了不一致的监测。在所有接受定期监测的患者中，约52%接受甲胎蛋白和超声检查，46%仅接受甲胎蛋白检查，2%仅接受超声检查。接受定期监测的患者更有可能生活在城市地区，收入高于未接受监测的患者。在诊断前，大约48%的患者由胃肠病学家/肝病学家或具有学术联系的医生就诊;他们接受定期监测的可能性分别是仅由初级保健医生就诊的患者的4.5倍和2.8倍。观察到监测的地理差异，并通过患者和医生因素进行解释。不到20%的肝硬化患者发生HCC后接受定期监测。胃肠病学家/肝病学家或有学术背景的医生更有可能进行监测。
Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended but may not be performed. The extent and determinants of HCC surveillance are unknown. We conducted a population-based US cohort study of those over 65 years of age to examine utilization and determinants of pre-diagnosis surveillance in patients with HCC who were previously diagnosed with cirrhosis. Patients diagnosed with HCC during 1994-2002 were identified from the linked Surveillance, Epidemiology, and End-Results registry-Medicare databases. We identified alpha-fetoprotein and ultrasound tests performed for HCC surveillance, and examined factors associated with surveillance. We identified 1,873 HCC patients with a prior diagnosis of cirrhosis. In the 3 years before HCC, 17% received regular surveillance and 38% received inconsistent surveillance. In a subset of 541 patients in whom cirrhosis was recorded for 3 or more years prior to HCC, only 29% received routine surveillance and 33% inconsistent surveillance. Among all patients who received regular surveillance, approximately 52% received both alpha-fetoprotein and ultrasound, 46% received alpha-fetoprotein only, and 2% received ultrasound only. Patients receiving regular surveillance were more likely to have lived in urban areas and had higher incomes than those who did not receive surveillance. Before diagnosis, approximately 48% of patients were seen by a gastroenterologist/hepatologist or by a physician with an academic affiliation; they were approximately 4.5-fold and 2.8-fold, respectively, more likely to receive regular surveillance than those seen by a primary care physician only. Geographic variation in surveillance was observed and explained by patient and physician factors. Less than 20% of patients with cirrhosis who developed HCC received regular surveillance. Gastroenterologists/hepatologists or physicians with an academic affiliation are more likely to perform surveillance.
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影响因子：
2.9
作者：
Hassan, MM;Frome, A;El-Serag, HB
通讯作者：
El-Serag, HB
影响因子：
29.4
作者：
Davila, JA;Morgan, RO;El-Serag, HB
通讯作者：
El-Serag, HB
影响因子：
25.7
作者：
El-Serag, HB;Siegel, AB;McGlynn, KA
通讯作者：
McGlynn, KA
影响因子：
12.6
作者：
Leykum, Luci K.;El-Serag, Hashem B.;Papadopoulos, Kyriakos P.
通讯作者：
Papadopoulos, Kyriakos P.
影响因子：
3
作者：
KAISER, HF
通讯作者：
KAISER, HF