Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in Taiwan
Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in Taiwan
复制标题
DOI：
10.1002/ijc.10122
复制
发表时间：
2002-03-10
影响因子：
6.4
通讯作者：
Duffy, SW
中科院分区：
文献类型：
--
作者：
Chen, THH;Chen, CJ;Duffy, SW
虽然以前的研究已经证明了超声(US)筛查能够发现小的无症状肝细胞癌(HCC)，但US筛查在减少肝细胞癌死亡方面的有效性仍然没有得到解决。根据US，我们设计了一个两阶段筛查计划，通过6个肝癌风险标志物来识别台湾7个乡镇的高危人群，并对6个标志物至少I阳性的人进行重复的US筛查，对患有肝硬变或其他慢性肝病的人进行3-6个月的间隔筛查，对其余结果正常的受试者实行年度筛查制度。对队列中的4843名受试者进行了平均7年的随访。我们比较了4385名参与者和458名非参与者，并对自我选择偏见进行了基线评估。此外，我们还评估了基线变量对肝癌发病率和死亡率以及对肝硬变发病率的影响。然后，对参与者和非参与者之间的死亡率差异进行了重新估计，并根据肝硬变、肝癌发病率和肝癌死亡的重要预测因素进行了调整，以进一步预防参与者和非参与者在风险特征方面的基线差异。美国对这一高危人群的筛查结果发现，与非参与者相比，参与者的死亡率降低了24%(95%CI：-52%至62%)。调整敏感度后，肝硬化组和非肝硬化组的平均停留时间分别为1.57年(95%CI：0.94~4.68)和2.66年(95%CI：1.68~6.37)。年龄、男性、乙肝表面抗原阳性、丙型肝炎抗体阳性、丙氨酸氨基转移酶和甲胎蛋白升高、有肝细胞癌家族史与发生肝细胞癌的危险性显著相关。显著增加的肝硬变风险与年龄、乙肝表面抗原、高谷丙转氨酶和甲胎蛋白升高相关。显著或接近显著的肝癌死亡风险增加与年龄、男性、乙肝表面抗原、高AST和AFP水平有关。对重要变量进行调整后，与非参与者相比，参与者的死亡率降低了41%(95%CI：-20至71%，p=0.1446)。本研究为在乙肝流行地区选择性高危人群中进行US筛查的有效性提供了提示性证据。随机对照试验将产生确凿的证据。在这样的试验方案中，建议对肝硬变患者进行较短的筛查间隔。(C)2002年Wiley-Liss，Inc.
Although previous studies have demonstrated the ability of ultrasonography (US) screening to detect small asymptomatic hepatocellular carcinoma (HCC), the efficacy of US screening in reducing deaths from HCC still remained unresolved. A 2-stage screening program was designed to identify a high risk group in 7 townships in Taiwan by 6 markers (of risk for HCC) and repeated US screening was further applied to those with at least I positive result for the 6 markers, with a range of 3- to 6-month inter-screening intervals to those with liver cirrhosis or other chronic liver diseases and an annual screening regime for the remaining subjects with normal findings according to US. The 4,843 subjects in this cohort were followed up for an average of 7 years. We compared 4,385 attenders with 458 non-attenders, in conjunction with baseline assessment for self-selection bias. In addition, we assessed baseline variables with respect to their effects on risk of incidence of and mortality from HCC and on risk of incidence of liver cirrhosis. The difference in mortality between attenders and non-attenders was then re-estimated adjusting for significant predictors of cirrhosis, HCC incidence and HCC death as a further guard against baseline differences between attenders and non-attenders in risk profiles. Results of US screening for this high risk group found the mortality was lower by 24% (95% Cl: -52 to 62%) in the attenders compared to the non-attenders. After adjustment for sensitivity, the mean sojourn time (MST) were 1.57 (95% CI: 0.94-4.68) for subjects with liver cirrhosis and 2.66 (95% Cl: 1.68-6.37) years for non-cirrhotic patient. Significant increases in risk of HCC incidence were associated with increasing age, male gender, hepatitis B surface antigen positive (HbsAg), hepatitis C antibody positive (Anti-HCV), high levels of alanine transaminase (ALT) and alpha-fetoprotein (AFP) and a family history of HCC. Significantly increased risks of liver cirrhosis were associated with predictors of cirrhosis were increasing age, HbsAg, high levels of ALT and of AFP. Significant or borderline significant increases in risk of HCC death were associated with increasing age, male gender, HbsAg, high levels of AST and AFP. Adjusted for the significant variables, the mortality was lower by 41% (95% Cl: -20 to 71%, p = 0.1446) in the attenders compared to the non-attenders. The present study provides suggestive evidence on the efficacy of US screening in a selective high risk group in an endemic area of hepatitis B. A randomized controlled trial would yield definitive evidence. Within the protocol of such a trial, a shorter interscreening interval for patients with liver cirrhosis is suggested. (C) 2002 Wiley-Liss, Inc.