Sonographic screening for hepatocellular carcinoma in patients with chronic hepatitis or cirrhosis: An evaluation
Sonographic screening for hepatocellular carcinoma in patients with chronic hepatitis or cirrhosis: An evaluation
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DOI：
10.2214/ajr.171.2.9694470
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发表时间：
1998-08-01
影响因子：
5
通讯作者：
Farrell, GC
中科院分区：
文献类型：
--
作者：
Larcos, G;Sorokopud, H;Farrell, GC
目标。本研究的目的是确定慢性肝炎或肝硬变患者中肝细胞癌的发生率，并评估超声筛查肝细胞癌的成本和效益。我们回顾了在8年时间里获得的232名患者的647个声像图。152名患者至少做了两次超声检查。包括154名男性和78名女性，平均年龄为51岁。大多数患者(n=207)都有经活检证实的肝硬变。分析种族、年龄、性别、肝病类型和cc-胎儿蛋白水平以确定与肝细胞癌检测相关的因素。超声检查和其他检查的费用根据澳大利亚政府的医疗保险福利计划计算。结果：31名患者(13%)甲胎蛋白水平升高。肝脏肿块25例(11%)。6例(2.6%)患者在活检(n=3)或其他检查中发现了肝细胞癌。所有病例均因肿瘤多中心或转移(n=2)或两者兼有，或因肿瘤体积较大或身体状况较差(n=4)或两者兼而有之而无法手术。唯一与检测到肝细胞癌相关的变量是酒精相关的肝病(p=0.01)。在六名肝细胞癌患者中，有一名甲胎蛋白水平升高。肝癌的年发病率为1.4%。超声显示的其他肿块包括再生结节(n=5)、血管瘤(n=5)、局灶性脂肪保留(n=4)、转移瘤(n=2)和其他病变(n=3)。没有患者接受手术切除，这排除了生存利益的计算。我们的筛查计划的成本是8472美元(美元)每个肝癌。结论：超声筛查在检测肝细胞癌方面优于cc-胎儿蛋白分析，但在本研究中，筛查并不能降低死亡率。
OBJECTIVE. The purposes of this study were to determine the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or cirrhosis and to assess the cost and benefit of sonographic screening for HCC.MATERIALS AND METHODS. We reviewed 647 sonograms of 232 patients obtained over an 8-year period. One hundred fifty-two patients had at least two sonograms. One hundred fifty-four men and 78 women with a mean age of 51 years were included. Most patients (n = 207) had biopsy-proven cirrhosis. Ethnicity, age, gender, type of liver disease, and cc-fetoprotein levels were analyzed to determine factors associated with HCC detection. The costs of sonography and other tests were calculated using the Australian government Medicare benefits schedule.RESULTS. Thirty-one patients (13%) had elevated a-fetoprotein levels. Liver masses were found in 25 (11%) patients. Six (2.6%) patients had HCC on biopsy (n = 3) or other tests. All cases of HCC were inoperable because of tumor multicentricity or metastases (n = 2) or both, or because of the relatively large size or poor physical condition of the patient (n = 4) or both. The only variable associated with detection of HCC was alcohol-related liver disease (p =.01). Of the six patients with HCC, one had an elevated a-fetoprotein level. The yearly incidence of HCC was 1.4%. Other masses shown by sonography included regenerating nodules (n = 5), he mangiomas (n = 5), focal fat sparing (n = 4), metastases (n = 2), and other lesions tit = 3). No patient underwent surgical resection, which precluded calculation of a survival benefit. The cost of our screening program was $8472 (United States dollars) per HCC.CONCLUSION. Sonographic screening is superior to cc-fetoprotein assay for detection of HCC, but in this study, screening did not decrease mortality.