Hepatocellular carcinoma surveillance rates in commercially insured patients with noncirrhotic chronic hepatitis B
Hepatocellular carcinoma surveillance rates in commercially insured patients with noncirrhotic chronic hepatitis B
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DOI：
10.1111/jvh.12381
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发表时间：
2015-09-01
影响因子：
2.5
通讯作者：
Lewis, J. D.
中科院分区：
文献类型：
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作者：
Goldberg, D. S.;Valderrama, A.;Lewis, J. D.
美国肝病研究协会（AASLD）和欧洲肝病研究协会（EASL）指南建议对慢性B肝炎感染（HBV）的非肝细胞性肝癌（HCC）患者进行半年一次的筛查，但没有数据估计监测率或与监测相关的因素。我们使用Truven Health Analytics数据库对2006年至2010年的美国患者进行了一项回顾性队列研究，并确定了非慢性HBV患者。监测模式的特点是使用分类和连续的结果，与时间的比例的连续测量最新的“与监测（PUTDS），与6个月的间隔后，每次超声分类为最新的”。在4576名非肝硬化慢性乙型肝炎患者（中位年龄：44岁，IQR：36-52）中，中位随访时间为26.0（IQR：16.2-40.0）个月，只有306名（6.7%）进行了完整的监测（每6个月进行一次超声检查），2727名（59.6%）不完整（1次超声检查），1543名（33.7%）无。平均PUTDS为0.34 ± 0.29，中位数为0.32（IQR：0.03-0.52）。在多项logistic回归模型中，由非胃肠病学家诊断的患者进行完全监测的可能性显著降低（P
American association for the study of liver diseases (AASLD) and European Association for the Study of the Liver (EASL) guidelines recommend biannual hepatocellular carcinoma (HCC) screening for noncirrhotic patients with chronic hepatitis B infection (HBV), yet there are no data estimating surveillance rates or factors associated with surveillance. We performed a retrospective cohort study of US patients using the Truven Health Analytics databases from 2006 to 2010 and identified patients with noncirrhotic chronic HBV. Surveillance patterns were characterized using categorical and continuous outcomes, with the continuous measure of the proportion of time up to date' with surveillance (PUTDS), with the 6-month interval following each ultrasound categorized as up to date'. During a median follow-up of 26.0 (IQR: 16.2-40.0) months among 4576 noncirrhotic patients with chronic HBV (median age: 44years, IQR: 36-52), only 306 (6.7%) had complete surveillance (one ultrasound every 6-month interval), 2727 (59.6%) incomplete (1 ultrasound) and 1543 (33.7%) none. The mean PUTDS was 0.34 +/- 0.29, and the median was 0.32 (IQR: 0.03-0.52). In multinomial logistic regression models, patients diagnosed by a nongastroenterologist were significantly less likely to have complete surveillance (P