Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis
Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis
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DOI：
10.1097/00000658-199804000-00011
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发表时间：
1998-04-01
影响因子：
9
通讯作者：
Curley, SA
中科院分区：
文献类型：
--
作者：
Izzo, F;Cremona, F;Curley, SA
我们在慢性肝炎病毒感染的患者中进行了这项前瞻性筛选试验，以确定肝细胞癌（HCC）的发病率以及这些HCC patients.Summary背景数据的可切除性和长期生存率慢性肝炎B或C病毒感染是人类HCC的主要病因。目前还不清楚，如果常规筛查慢性病毒性肝炎患者提高了谁发展hcch.MethodsScreening肝癌患者的生存提供慢性血清阳性（>5年）的肝炎B或C感染。所有患者均接受经皮肝穿刺活检，以评估慢性肝损伤的组织学严重程度。患者进行筛选，最初和每3个月后，血清甲胎蛋白和经腹超声评价;肝细胞癌确诊肝肿瘤的穿刺活检。结果筛选进行了1125例肝炎阳性患者（804丙型肝炎，290乙型肝炎B，31两者）。在肝活检中，800名患者患有轻度慢性活动性肝炎，325名患者患有重度慢性活动性肝炎、肝硬化或两者兼而有之。在61例患者中初步筛查发现了HCC。在随访期间，在另外6名患者中检测到HCC;因此，HCC的发生率为5.9%（67/1125）。然而，67例HCC病例中的66例（98.5%）发生在325例重度慢性活动性肝炎或肝硬化患者中（66/325 [20.3%] vs. 1/800 [0.1%]，p < 0.0001 [Wilcoxon符号秩]）。67例HCC患者的中位随访时间为24个月。43例患者（64.2%）发生了局部晚期或转移性、不可切除的HCC; 24例患者（35.8%），包括随访筛选期间检测到的6例患者，接受了边缘阴性切除术。24名切除患者的中位生存期为26个月，而43名不可切除癌症患者的中位生存期为6个月（p < 0.0001，Wilcoxon符号等级）。结论发现20.3%的慢性B或丙型肝炎感染和严重肝损伤患者出现肝癌。在不到一半的HCC患者中，初步筛查发现了可切除的病变。慢性B或C型肝炎病毒感染患者的常规超声筛查和甲胎蛋白测定应保留给重度慢性活动性肝炎、肝硬化或两者兼有的患者。
ObjectiveWe performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and long-term survival rates of these HCC patients.Summary Background DataChronic hepatitis B or C virus infection is a major etiologic factor in human HCC. It is not clear if routine screening of chronic viral hepatitis patients improves the survival of patients who develop HCC.MethodsScreening for HCC was offered to patients chronically seropositive (>5 years) for hepatitis B or C infection. All patients underwent percutaneous core liver biopsy to assess the histologic severity of chronic liver injury. Patients were screened initially and every 3 months thereafter with serum alpha-fetoprotein and transabdominal ultrasound evaluations; HCC was confirmed by needle biopsy of liver tumors.ResultsScreening was performed on 1125 hepatitis-positive patients (804 with hepatitis C, 290 with hepatitis B, 31 with both). On liver biopsy, 800 patients had mild chronic active hepatitis and 325 had severe chronic active hepatitis, cirrhosis, or both. Initial screening detected HCC in 61 patients. HCC was detected in six more patients during follow-up; thus, the incidence of HCC was 5.9% (67/1125). However, 66 of the 67 HCC cases (98.5%) arose in the 325 patients with severe chronic active hepatitis or cirrhosis (66/325 [20.3%] vs. 1/800 [0.1%], p < 0.0001 [Wilcoxon signed rank]). Median follow-up of the 67 HCC patients was 24 months. Locally advanced or metastatic, unresectable HCC occurred in 43 patients (64.2%); 24 patients (35.8%), including the 6 patients detected during follow-up screening, underwent margin-negative resection. The median survival for the 24 resected patients was 26 months, compared to 6 months for the 43 patients with unresectable cancer (p < 0.0001, Wilcoxon signed rank).ConclusionsHCC was found to arise in 20.3% of patients with chronic hepatitis B or C infection and severe liver injury. Initial screen ing detected resectable lesions in less than half the HCC patients. Routine screening of chronic hepatitis B or C virus-infected patients with ultrasound and alpha-fetoprotein determination should be reserved for patients with severe chronic active hepatitis, cirrhosis, or both.