Benefits and Harms of Hepatocellular Carcinoma Surveillance in a Prospective Cohort of Patients With Cirrhosis.
Benefits and Harms of Hepatocellular Carcinoma Surveillance in a Prospective Cohort of Patients With Cirrhosis.
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肝硬化患者前瞻性队列中肝细胞癌监测的益处和危害。
DOI：
10.1016/j.cgh.2020.09.014
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Marrero JA
中科院分区：
文献类型：
--
作者：
Singal AG;Patibandla S;Obi J;Fullington H;Parikh ND;Yopp AC;Marrero JA
癌症筛查项目的价值取决于其利弊的平衡；然而，很少有数据评估肝细胞癌（HCC）监测的这两个属性。我们的目的是在一个大型的肝硬化患者前瞻性队列中描述HCC监测的益处和危害。我们对一项临床试验进行了二次分析，该试验评估了2014年12月至2015年7月在安全网卫生系统中登记的肝硬化患者的HCC监测情况。在18个月的时间里，我们量化了监测相关的益处，定义为早期HCC检测和治疗接受，以及身体伤害，定义为假阳性或不确定结果的诊断程序。614例≥1次监测检查的肝硬化患者中，有118例（19.2%）出现异常。随访期间26例发生HCC，其中监测发现16例（61.5%）。在BCLC 0/A期检测到HCC的比例（62.5% vs 50%, p=0.69）和接受根治性治疗的比例（43.8% vs 40.0%, p=1.0）在监测检测的患者和偶然/症状诊断的患者之间没有显著差异。在接受监测的54例（8.8%）患者中观察到身体伤害——大多数严重程度较轻，只有一次CT或MRI诊断，没有进行活检等侵入性检查。40例（6.5%）患者在随访影像学中发现偶然发现，其中23例临床重要性低，17例临床重要性中等。在我们的肝硬化患者队列中，HCC监测与高早期肿瘤检出率和最小的身体伤害相关。
The value of a cancer screening programs is defined by its balance of benefits and harms; however, there are few data evaluating both attributes for hepatocellular carcinoma (HCC) surveillance. We aimed to characterize benefits and harms of HCC surveillance in a large prospective cohort of patients with cirrhosis. We conducted a secondary analysis of a clinical trial evaluating HCC surveillance among patients with cirrhosis at a safety-net health system enrolled between December 2014 and July 2015. We quantified surveillance-related benefits, defined as early HCC detection and curative treatment receipt, and physical harms, defined as diagnostic procedures for false positive or indeterminate results, over an 18-month period. Of 614 cirrhosis patients with ≥1 surveillance exam, abnormal results were observed in 118 (19.2%) patients. Twenty-six patients developed HCC during follow-up, of whom 16 (61.5%) were detected by surveillance. The proportion of HCC detected at BCLC stage 0/A (62.5% vs 50%, p=0.69) and who underwent curative treatment (43.8% vs. 40.0%, p=1.0) did not significantly differ between surveillance-detected patients and those diagnosed incidentally/symptomatically. Physical harms were observed in 54 (8.8%) patients who underwent surveillance – most of mild severity with only one diagnostic CT or MRI and none undergoing invasive testing such as biopsy. Incidental findings on follow-up imaging were found in 40 (6.5%) patients —23 of low clinical importance and 17 medium clinical importance. In our cohort of patients with cirrhosis, HCC surveillance was associated with high early tumor detection and minimal physical harms.
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肝硬化患者的肝细胞癌筛查与癌症相关的死亡率降低之间没有关联。
影响因子：
29.4
作者：
Moon AM;Weiss NS;Beste LA;Su F;Ho SB;Jin GY;Lowy E;Berry K;Ioannou GN
通讯作者：
Ioannou GN
影响因子：
7.6
作者：
Simmons, O.;Fetzer, D. T.;Singal, A. G.
通讯作者：
Singal, A. G.
影响因子：
13.5
作者：
Singal, Amit G.;Tiro, Jasmin A.;Halm, Ethan A.
通讯作者：
Halm, Ethan A.
影响因子：
29.4
作者：
Tzartzeva K;Obi J;Rich NE;Parikh ND;Marrero JA;Yopp A;Waljee AK;Singal AG
通讯作者：
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影响因子：
13.5
作者：
Atiq, Omair;Tiro, Jasmin;Singal, Amit G.
通讯作者：
Singal, Amit G.