Effectiveness of hepatocellular carcinoma surveillance in patients with cirrhosis.
Effectiveness of hepatocellular carcinoma surveillance in patients with cirrhosis.
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DOI：
10.1158/1055-9965.epi-11-1005
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发表时间：
2012-05
期刊：
影响因子：
--
通讯作者：
Marrero JA
中科院分区：
文献类型：
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作者：
Singal AG;Conjeevaram HS;Volk ML;Fu S;Fontana RJ;Askari F;Su GL;Lok AS;Marrero JA
建议在肝硬变患者中监测肝细胞癌，但监测计划在临床实践中的有效性尚未确定。目的：评价超声和甲胎蛋白(AFP)监测项目检测早期肝癌的有效性。在2004年1月至2006年9月期间，前瞻性地纳入了446名Child A/B级肝硬变患者，并对其进行了跟踪调查，直至2010年7月。每名接受治疗的肝科医生使用超声和AFP进行肝细胞癌监测，尽管标准是每6至12个月进行一次。根据美国肝病研究协会(AASLD)的指南和巴塞罗那临床肝癌(BCLC)分期定义的早期肝细胞癌进行诊断。使用甲胎蛋白、超声或两者的组合来确定监测的性能特征。中位随访3.5年后，41例患者发展为肝癌，其中30例(73.2%)为早期肝癌。年发病率为2.8%，3年和5年累计发病率分别为5.7%和9.1%。监测超声和甲胎蛋白检测肝癌的敏感性分别为44%和66%，特异性分别为92%和91%。当这些测试联合使用时，敏感性显著提高到90%，特异性损失最小(83%)。在实际临床应用中，超声和甲胎蛋白联合应用是早期发现肝细胞癌最有效的策略。我们的结果与AASLD的指导方针不同。
Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis, but the effectiveness of a surveillance program in clinical practice has yet to be established. To evaluate the effectiveness of a surveillance program with ultrasound and alpha-fetoprotein (AFP) to detect early HCCs. Four hundred and forty-six patients with Child A/B cirrhosis were prospectively enrolled between January 2004 and September 2006 and followed until July 2010. HCC surveillance using ultrasound and AFP was conducted per the treating hepatologist, although the standard was every 6 to 12 months. HCC was diagnosed using American Association for the Study of Liver Disease (AASLD) guidelines and early HCC defined by Barcelona Clinic Liver Cancer (BCLC) staging. Performance characteristics were determined for surveillance using AFP, ultrasound, or the combination. After a median follow-up of 3.5 years, 41 patients developed HCCs, of whom 30 (73.2%) had early HCCs. The annual incidence of HCC was 2.8%, with cumulative 3- and 5-year incidence rates of 5.7% and 9.1%, respectively. Surveillance ultrasound and AFP had sensitivities of 44% and 66% and specificities of 92% and 91%, respectively, for the detection of HCCs. Sensitivity significantly improved to 90%, with minimal loss in specificity (83%) when these tests were used in combination. When used as a surveillance program in a real-world clinical setting, combination of ultrasound and AFP is the most effective strategy to detect HCC at an early stage. Our results differ from the guidelines of the AASLD.