Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis.
Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis.
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肝硬化患者的肝细胞癌监测模式和结果。
DOI：
10.1016/j.cgh.2023.08.003
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Yang,
中科院分区：
文献类型：
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作者：
Daher,Darine;SeifElDahan,Karim;Cano,Alva;Gonzales,Michael;Ransom,Crystal;Jaurez,Erik;Carranza,Osiris;Quirk,Lisa;Morgan,Todd;Gopal,Purva;Patel,MadhukarS;Lieber,Sarah;Louissaint,Jeremy;Cotter,ThomasG;VanWagner,LisaB;Yang,
背景与目的肝细胞癌的监测与早期发现的改善和死亡率的降低有关，尽管临床实践中的实践模式和有效性有所不同。方法我们对2008年1月至2022年12月在美国两个大型卫生系统中诊断为肝癌的患者进行了一项回顾性队列研究。我们记录了肝癌诊断前一年的影像收据：超声+甲胎蛋白(α-FetoProtein)，单独超声，多时相对比增强计算机体层摄影(CT)/磁共振成像(MRI)，没有肝脏成像。结果在2028例肝细胞癌患者(46.7%的巴塞罗那临床肝癌A期)中，703例(34.7%)行超声联合甲胎蛋白治疗，293例(14.5%)单纯行超声检查，326例(16.1%)行多期CT/MRI检查，706例(34.8%)未行超声检查。在研究期间，没有成像的比例是稳定的，而CT/MRI的使用增加了。CT/MRI和B超联合AFP对早期肝癌的检出和治疗均有影响，但与单纯超声无关。与单独使用B超相比，CT/MRI和B超加AFP的早期发现率更高。结论在临床实践中，肝细胞癌的监测模式不同，其临床结果也不同。在等待数据以确定是否可以在选定的患者中以成本效益的方式进行CT或MRI监测时，AFP对基于超声波的监测具有补充作用，支持其在实践指南中采用。
Background & AimsHepatocellular carcinoma (HCC) surveillance is associated with improved early detection and reduced mortality, although practice patterns and effectiveness vary in clinical practice. We aimed to characterize HCC surveillance patterns in a large, diverse cohort of patients with HCC.MethodsWe conducted a retrospective cohort study of patients diagnosed with HCC between January 2008 and December 2022 at 2 large US health systems. We recorded imaging receipt in the year before HCC diagnosis: ultrasound plus α-fetoprotein (AFP), ultrasound alone, multiphasic contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI), and no liver imaging. We used multivariable logistic and Cox regression analysis to compare early tumor detection, curative treatment receipt, and overall survival between surveillance strategies.ResultsAmong 2028 patients with HCC (46.7% Barcelona Clinic Liver Cancer stage A), 703 (34.7%) had ultrasound plus AFP, 293 (14.5%) had ultrasound alone, 326 (16.1%) had multiphasic CT/MRI, and 706 (34.8%) had no imaging in the year before HCC diagnosis. Over the study period, proportions without imaging were stable, whereas use of CT/MRI increased. Compared with no imaging, CT/MRI and ultrasound plus AFP, but not ultrasound alone, were associated with early stage HCC detection and curative treatment. Compared with ultrasound alone, CT/MRI and ultrasound plus AFP were associated with increased early stage detection.ConclusionsHCC surveillance patterns vary in clinical practice and are associated with differing clinical outcomes. While awaiting data to determine if CT or MRI surveillance can be performed in a cost-effective manner in selected patients, AFP has a complementary role to ultrasound-based surveillance, supporting its adoption in practice guidelines.