Does Hepatocellular Carcinoma Surveillance Increase Survival in At-Risk Populations? Patient Selection, Biomarkers, and Barriers.
Does Hepatocellular Carcinoma Surveillance Increase Survival in At-Risk Populations? Patient Selection, Biomarkers, and Barriers.
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DOI：
10.1007/s10620-020-06550-6
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发表时间：
2020-12
影响因子：
3.1
通讯作者：
Mehta N
中科院分区：
文献类型：
--
作者：
Deng LX;Mehta N
肝细胞癌（HCC）是一种全球发病率高、发病率高的癌症。虽然缺乏高质量的证据来证明HCC监测对死亡率的好处，但早期发现HCC可能是有益的，因为预后与肿瘤分期高度相关。高危人群，包括肝硬化患者和乙型肝炎亚组，应每隔6个月接受超声±甲胎蛋白（AFP）监测。此外，新出现的数据表明，获得持续病毒学应答的丙型肝炎肝硬化患者应继续监测。需要进一步的研究来确定监测在无肝硬化或其他病因的晚期纤维化的非酒精性脂肪性肝病患者中的价值。新的生物标志物和模型，如AFP凝集素反应分数、des-γ-羧基凝血酶原和GALAD评分，越来越多地用于HCC的诊断和预后。这些生物标志物在监测中的作用仍在调查中，但可能为传统的基于图像的监测提供更实用的替代方案。尽管有多个专业协会指南的建议，但由于患者、临床医生和卫生保健系统层面的障碍，许多高危患者没有接受HCC监测。实施患者导航服务、对临床医生进行监测指南教育和创建自动化外展系统等策略可能会提高监测率，并最终降低HCC的发病率和死亡率。
Hepatocellular carcinoma (HCC) is a highly morbid and prevalent cancer globally. While high quality evidence for mortality benefit of HCC surveillance is lacking, early detection of HCC is likely beneficial as prognosis is highly correlated with tumor stage. High risk populations, including patients with cirrhosis and subgroups with Hepatitis B, should undergo surveillance with ultrasound ± alpha-fetoprotein (AFP) at 6-month intervals. In addition, emerging data suggest that patients with Hepatitis C cirrhosis who achieve sustained virologic response should continue surveillance. Further research is needed to determine the value of surveillance in patients with nonalcoholic fatty liver disease in the absence of cirrhosis or with advanced fibrosis of other etiologies. Newer biomarkers and models such asLens culinarisagglutinin-reactive fraction of AFP, des-γ-carboxy prothrombin, and the GALAD score are increasingly utilized in the diagnosis and prognostication of HCC. The role of these biomarkers in surveillance is still under investigation but may potentially offer a more practical alternative to traditional image-based surveillance. Despite recommendations from multiple professional society guidelines, many at-risk patients do not receive HCC surveillance due to barriers at the patient, clinician, and health care system levels. Strategies such as implementing patient navigation services, educating clinicians about surveillance guidelines, and creating automated outreach systems, may improve surveillance rates and ultimately reduce morbidity and mortality from HCC.
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