Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial: where did surveillance fail?
Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial: where did surveillance fail?
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DOI：
10.1038/ajg.2012.449
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Lee WM
中科院分区：
文献类型：
--
作者：
Singal AG;Nehra M;Adams-Huet B;Yopp AC;Tiro JA;Marrero JA;Lok AS;Lee WM
只有40%的肝细胞癌（HCC）患者在早期被诊断出来，这表明监测过程中存在故障。我们研究的目的是评估丙型肝炎抗病毒长期治疗肝硬化试验（HALT-C）中患者监测过程失败的原因，该试验前瞻性收集了大型患者队列的HCC监测数据。二元回归分析用于确定一致性监测的预测因素，其定义为每12个月进行一次超声和甲胎蛋白检查。发生HCC的患者监测失败分为三类：缺乏筛查、缺乏随访或缺乏检测。在平均6.1年的随访中，1,005例患者中有692例（68.9%）接受了持续监测。研究中心是持续监测的最强预测因素（P < 0.001）。调整研究中心后，患者水平的一致监测预测因素包括血小板计数> 150，000/mm 3（风险比（HR）1.28; 95%置信区间（CI）：1.05-1.56）和完全门诊访视依从性（HR 1.72，95% CI：1.11-2.63）。在83例HCC患者中，23例（27.7%）超出米兰标准。3例（13%）由于缺乏筛查而患有晚期HCC，4例（17%）由于缺乏随访，16例（70%）由于缺乏检测。监测过程失败，包括缺乏筛查或随访，是常见的，并可能导致三分之一的病例出现晚期肿瘤。然而，在晚期发现HCC的最常见原因是缺乏检测，这表明需要更好的监测策略。
Only 40% of patients with hepatocellular carcinoma (HCC) are diagnosed at an early stage, suggesting breakdowns in the surveillance process. The aim of our study was to assess the reasons behind surveillance process failures among patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C), which prospectively collected HCC surveillance data on a large cohort of patients. Binary regression analysis was used to identify predictors of consistent surveillance, which was defined as having an ultrasound and alpha-fetoprotein every 12 months. Surveillance failures among patients who developed HCC were classified into one of three categories: absence of screening, absence of follow-up, or absence of detection. Over a mean follow-up of 6.1 years, 692 (68.9%) of 1,005 patients had consistent surveillance. Study site was the strongest predictor of consistent surveillance (P < 0.001). After adjusting for study site, patient-level predictors of consistent surveillance included platelet count >150,000/mm3 (hazard ratio (HR) 1.28; 95% confidence interval (CI): 1.05–1.56) and complete clinic visit adherence (HR 1.72, 95% CI: 1.11–2.63). Of 83 patients with HCC, 23 (27.7%) were detected beyond Milan criteria. Three (13%) had late-stage HCC due to the absence of screening, 4 (17%) due to the absence of follow-up, and 16 (70%) due to the absence of detection. Surveillance process failures, including absence of screening or follow-up, are common and potentially contribute to late-stage tumors in one-third of cases. However, the most common reason for finding HCC at a late stage was an absence of detection, suggesting better surveillance strategies are needed.
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影响因子：
5.1
作者：
Marrero, Jorge A
通讯作者：
Marrero, Jorge A
DOI：
10.1158/1055-9965.epi-11-1005
发表时间：
2012-05
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Singal AG;Conjeevaram HS;Volk ML;Fu S;Fontana RJ;Askari F;Su GL;Lok AS;Marrero JA
通讯作者：
Marrero JA
影响因子：
10.3
作者：
Leyden, WA;Manos, MM;Taplin, SH
通讯作者：
Taplin, SH
影响因子：
10.3
作者：
Taplin, SH;Ichikawa, L;Barlow, WE
通讯作者：
Barlow, WE
影响因子：
2.9
作者：
Singal, Amit G.;Volk, Michael L.;Marrero, Jorge A.
通讯作者：
Marrero, Jorge A.