Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA
Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA
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DOI：
10.1136/gut.2010.230508
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发表时间：
2011-07-01
期刊：
影响因子：
24.5
通讯作者：
Davila, Jessica A.
中科院分区：
文献类型：
--
作者：
El-Serag, Hashem B.;Kramer, Jennifer R.;Davila, Jessica A.
背景与目的
美国肝细胞癌（HCC）监测的有效性在很大程度上尚不明确。本研究的目的是利用美国退伍军人管理局（VA）全国丙型肝炎病毒（HCV）临床病例登记系统，在VA的全国临床实践环境中评估HCC监测的有效性。
方法
研究队列包括1998 - 2007年间患HCC的1480例HCV感染患者。对接受甲胎蛋白（AFP）检测和腹部超声（US）用于HCC监测的时间和频率进行了评估。采用Cox比例风险回归模型，对人口统计学特征、临床特征以及是否接受HCC特异性治疗进行校正后，分析了总体死亡风险。
结果
HCC确诊后的平均生存期为1.8年。在HCC确诊前2年内，77.8%的患者有监测AFP或US的记录。只有2%的患者每年同时进行AFP和US监测。与未监测相比，在HCC确诊前0 - 6个月和7 - 24个月两个时间段内，有AFP或US监测的患者死亡风险较低（风险比[HR] 0.71，95%置信区间[CI] 0.62 - 0.82）。在HCC确诊前0 - 6个月接受两次或更多次监测检查（HR 0.76，95%CI 0.66 - 0.88）以及在7 - 12个月在较小程度上（HR 0.81，95%CI 0.1 - 0.99）也与死亡风险降低相关。
结论
大多数HCV相关肝硬化患者未接受定期的基于影像学的监测。在当前临床实践中，HCC监测检查在降低HCC相关死亡率方面的有效性相当有限。
Background and aims The effectiveness of surveillance for hepatocellular carcinoma (HCC) in the USA is largely unknown. The objective of this study was to evaluate the effectiveness of HCC surveillance in a national Veterans Administration (VA) practice setting, using the national VA hepatitis C virus (HCV) Clinical Case Registry.Method The cohort consisted of 1480 HCV-infected patients who developed HCC during 1998-2007. The timing and intensity of receiving a-fetoprotein (AFP) and abdominal ultrasound (US) for HCC surveillance were evaluated. Overall mortality risk was examined using Cox proportional hazards regression models adjusting for demographics, clinical features and receipt of HCC-specific treatment.Results The mean survival was 1.8 years following the HCC diagnosis date. Surveillance AFP or US were recorded in 77.8% of patients within 2 years prior to HCC diagnosis. Annual surveillance with both AFP and US was observed in only 2% of patients. The presence of either AFP or US surveillance during both 0-6 month and 7-24 month periods before HCC diagnosis was associated with a lower mortality risk (HR 0.71, 95% CI 0.62 to 0.82) compared with no surveillance. Receipt of two or more surveillance tests in the 0-6 months (HR 0.76 95% CI 0.66 to 0.88) and to a lesser extent in the 7-12 months (HR 0.81 95% CI 0.1 to 0.99) prior to HCC diagnosis was also associated with reduced mortality risk.Conclusions Most patients with HCV-related cirrhosis do not receive regular imaging-based surveillance. The effectiveness of HCC surveillance tests in current clinical practice is rather modest in reducing HCC-related mortality.