[Community-based hepatocellular carcinoma screening in seven townships in Taiwan].
[Community-based hepatocellular carcinoma screening in seven townships in Taiwan].
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台湾七乡社区肝癌筛查[J].
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
H. Lee
中科院分区：
文献类型：
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作者：
C. Chen;S. N. Lu;S. You;M. Wu;L. Y. Wang;L. Lee;G. Huang;P. Yang;H. Lee
肝细胞癌的早期发现和及时治疗可以延长患者的生命，提高患者的生活质量。为了比较各种筛查生物标志物的敏感度和特异度，识别肝癌的高危人群，估计肝癌的患病率和发病率，在台湾岛的三池、楚东、波祖和高旭，以及澎湖岛的马公、虎溪和排沙实施了以社区为基础的肝癌筛查项目。根据乙肝表面抗原、丙型肝炎病毒抗体、甲胎蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、天冬氨酸转氨酶、甲胎蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、丙型肝炎病毒抗体、甲胎蛋白、丙氨酸氨基转移酶、天冬氨酸转氨酶、丙型肝炎病毒抗体、甲胎蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、丙氨酸氨基至少符合上述六项第一阶段标准之一的受试者被转介进行腹部超声第二阶段筛查。可疑病例经抽吸细胞学、手术病理、数字减影血管造影和/或计算机体层摄影确诊。共招募澎湖7个研究乡镇的12,026名男性和2个乡镇的1,800名女性进行第一阶段筛查(应答率：男性25.5%；女性46.8%)。一期筛查男性阳性率为30.9%，女性为34.6%。第二阶段筛查的应答率男性为91%，女性为90.5%。澎湖岛男性每千人肝癌标化患病率为5.2人，女性为0.8人，台湾岛男性为1.2人。在5种血清学标志物中，HBs Ag携带者的敏感性最高(88.2%)，AFP次之(43.1%)。这些标志物对AFP的特异度最高(99.0%)，对HBs Ag携带者的特异度最低(80.3%)。在对137例受肝硬变影响的患者进行密集随访后，发现了16例新的肝癌病例，其年肝癌发病率为5.3%，而非肝硬化组第一阶段筛查阳性者的发病率仅为0.15%。乙肝表面抗原和甲胎蛋白联合用于一期筛查，腹部超声用于二期筛查似乎对肝癌的早期发现是有效的，但其成本-效果有待更长时间的随访研究来阐明。
The early detection and prompt treatment of hepatocellular carcinoma (HCC) may prolong life and improve the quality of life of affected patients. In order to compare sensitivity and specificity of various screening biomarkers, identify subjects with a high risk of developing HCC, and estimate prevalence and incidence of HCC among subjects, a community-based HCC screening program was implemented in Sanchi, Chutung, Potzu, and Kaohsu, Taiwan Island as well as Makung, Huhsi and Paihsa in Penghu Islets. First stage screening of HCC was based on serological markers including hepatitis B surface antigen (HBsAg), antibody against hepatitis C virus (anti-HCV), alpha-fetoprotein (AFP > or = 20 ng/mL), alanine transaminase (> or = 40 IU/L), and aspartate transaminase (> or = 45 IU/L); as well as history of liver cirrhosis or HCC among first-degree relatives. Subjects who were positive for at least one of above six first-stage criteria were referred for second-stage screening by abdominal ultrasonography. Confirmatory diagnosis of HCC was made in suspicious cases according to aspiration cytology surgical pathology, digital substracted angiogram and/or computed tomography. A total of 12,026 men in seven study townships and 1,800 women in two townships in Penghu were recruited for first-stage screening (response rate: men, 25.5%; women, 46.8%). The positive rates for first-stage screening were 30.9% men and 34.6% women. The response rates for second-stage screening were 91% men and 90.5% women. Age-standardized prevalence of HCC per 1,000 subjects was 5.2 for men and 0.8 for women in Penghu Islets and 1.2 for men on Taiwan island. Among five serological biomarkers, HBsAg carrier status had the highest sensitivity (88.2%) and AFP had the second highest sensitivity (43.1%). The specificity of these markers was highest for AFP (99.0%) and lowest for HBsAg carrier status (80.3%). There were 16 new HCC cases identified after an intensive follow-up of 137 cases affected with liver cirrhos is giving an annual HCC incidence rate of 5.3%, while the rate for non-cirrhotic subjects who were positive on first-stage screening was only 0.15%. The combination of HBsAg and AFP for the first-stage screening and abdominal ultrasonography for the second-state screening seems valid for the early detection of HCC, but its cost-effectiveness remains to be elucidated by a longer follow-up study.