Screening for hepatocellular carcinoma in patients with advanced cirrhosis
Screening for hepatocellular carcinoma in patients with advanced cirrhosis
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DOI：
10.1016/s0002-9270(99)00504-3
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发表时间：
1999-10-01
影响因子：
9.8
通讯作者：
Lumeng, L
中科院分区：
文献类型：
--
作者：
Chalasani, N;Horlander, JC;Lumeng, L
目的：大多数关于肝硬化患者肝细胞癌（HCC）筛查的可用数据来自亚洲和欧洲。这些数据可能不适用于来自美国的患者，因为潜在病因和其他因素的地理差异。我们的目标是评估美国肝硬化患者接受标准化screening.METHODS的风险肝癌：所有的肝硬化患者评估肝移植在我们的机构从1994年1月1日至1997年12月31日，包括在这项研究中。筛查策略包括初步筛选，这是提供给所有患者，包括甲胎蛋白（AFP），腹部超声，计算机断层扫描（CT）扫描，和扩展筛选，这是只对移植合格的患者，包括半年AFP和ultrason.RESULTS：在研究期间，285例肝硬化患者进行了评估移植，并进行初步筛选。其中，166例符合移植条件，并在中位随访15个月（范围6-42个月）期间进行了扩展筛选。发现27例HCC，22例在初始筛查期间，5例在扩展筛查期间。在1年、2年和3.5年时接受扩展筛查的队列的无癌比例分别为98.6% +/-1.4%、96.4 +/-1.8%和77.1% +/-1.7%（平均值+/- SE）。丙型肝炎，无论是单独或部分，是63%的HCC患者的病因。CT扫描的敏感性（88%）显著高于AFP >20 ng/ml（62%）和超声（59%）检测HCC（p < 0.001）。结论：在已确诊的肝硬化患者中，基线筛查时检测HCC的风险最高（7%）。丙型肝炎是研究中肝硬化最常见的病因。在美国肝硬化患者中，CT扫描检测HCC的灵敏度高于超声或AFP。(C)1999年，我胃肠病学。
OBJECTIVE: Most available data on screening for hepatocellular carcinoma (HCC) in patients with cirrhosis originate from Asia and Europe. These data may not be applicable to patients from the United States because of geographic variation in the underlying etiology and other factors. Our him was to assess the risk of HCC in U.S. patients with cirrhosis undergoing standardized screening.METHODS: All cirrhotic patients evaluated for liver transplantation at our institution from January 1, 1994 -December 31, 1997 were included in this study. The screening strategy included initial screening, which was offered to all patients and consisted of alpha-fetoprotein (AFP), abdominal ultrasound, and computed tomography (CT) scan, and extended screening, which was performed only on transplant-eligible patients and consisted of semiannual AFP and ultrasound.RESULTS: During the study period, 285 patients with cirrhosis were evaluated for transplantation and underwent initial screening. Of these, 166; were eligible for transplantation and underwent extended screening during a median follow-up of 15 months (range 6-42 months). Twenty-seven HCC were found, 22 during initial screening and five during extended screening. The cancer-free proportions of the cohort who underwent extended screening at 1, 2, and 3.5 yr were 98.6% +/- 1.4%, 96.4 +/- 1.8%, and 77.1% +/- 1.7%, respectively (mean +/- SE). Hepatitis C, either alone or in part, was the etiology in 63% of patients with HCC. The sensitivity of CT scan (88%) was significantly higher than AFP >20 ng/ml (62%) and ultrasound (59%) for detecting HCC (p < 0.001).CONCLUSIONS: In patients with established cirrhosis, the risk of detecting HCC is maximal at the baseline screening (7%). Hepatitis C was the most common etiology for cirrhosis in study. In U.S. patients with established cirrhosis, CT scan exhibited higher sensitivity for detecting HCC than ultrasound or AFP. (C) 1999 by Am. Coll. of Gastroenterology.