Use of Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis: A Systematic Review and Meta-Analysis.
Use of Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis: A Systematic Review and Meta-Analysis.
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肝细胞癌监测在肝硬化患者中的应用：一项系统综述和荟萃分析。
DOI：
10.1002/hep.31309
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Singal AG
中科院分区：
文献类型：
--
作者：
Wolf E;Rich NE;Marrero JA;Parikh ND;Singal AG
肝细胞癌 (HCC) 监测与早期肿瘤发现和提高生存率相关；然而，它在临床实践中经常未被充分利用。我们的目的是描述肝硬化患者监测的利用情况以及加强监测的干预措施的有效性。我们使用 2010 年 1 月至 2018 年 8 月期间的 MEDLINE 数据库进行了系统性文献综述，以确定评估肝硬化患者 HCC 监测或加强监测的干预措施的队列研究。计算了具有 95% 置信区间的监测接收的汇总估计值。根据每项研究和预先指定的亚组分析定义了监测利用的相关性。共有 118,799 名患者参与的 29 项研究符合纳入标准，监测利用率的汇总估计值为 24.0% (95%CI 18.4 – 30.1)。在亚组分析中，对从亚专科胃肠病学/肝病学诊所入组的患者进行的研究中报告的监测收率最高，而在基于人群的队列中进行监测的研究中报告的监测收率最低（73.7% vs. 8.8%，p<0.001）。普遍报告的监测相关性包括患者的接收率较高，其次是亚专科医生，而酒精或 NASH 相关肝硬化患者的接收率较低。所有八项研究 (n=5229) 评估干预措施，包括患者/提供者教育、影响范围（例如提醒和回忆系统）以及人口健康外展策略，报告监测接收率显着增加（范围 9.4% – 63.6%）。 HCC 监测在临床实践中仍未得到充分利用，特别是在酒精或 NASH 相关肝硬化患者以及未在专科胃肠病诊所进行随访的患者中。提供者教育、包括提醒系统在内的影响力和人口健康外展工作等干预措施可以显着增加 HCC 监测。
Hepatocellular carcinoma (HCC) surveillance is associated with early tumor detection and improved survival; however, it is often underused in clinical practice. We aimed to characterize surveillance utilization among patients with cirrhosis and the efficacy of interventions to increase surveillance. We performed a systematic literature review using the MEDLINE database from January 2010 through August 2018 to identify cohort studies evaluating HCC surveillance receipt, or interventions to increase surveillance, in patients with cirrhosis. A pooled estimate for surveillance receipt with 95% confidence intervals was calculated. Correlates of surveillance utilization were defined from each study and pre-specified subgroup analyses. Twenty-nine studies, with a total of 118,799 patients, met inclusion criteria, with a pooled estimate for surveillance utilization of 24.0% (95%CI 18.4 – 30.1). In subgroup analyses, the highest surveillance receipt was reported in studies with patients enrolled from subspecialty Gastroenterology/Hepatology clinics and lowest in studies characterizing surveillance in population-based cohorts (73.7% vs. 8.8%, p<0.001). Commonly reported correlates of surveillance included higher receipt among patients followed by subspecialists and lower receipt among those with alcohol- or NASH-related cirrhosis. All eight studies (n=5229) evaluating interventions including patient/provider education, inreach (e.g. reminder and recall systems), and population health outreach strategies reported significant increases (range 9.4% – 63.6%) in surveillance receipt. HCC surveillance continues to remain underused in clinical practice, particularly among patients with alcohol- or NASH-related cirrhosis and those not followed in subspecialty gastroenterology clinics. Interventions such as provider education, inreach including reminder systems and population health outreach efforts can significantly increase HCC surveillance.
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影响因子：
39
作者：
Baker, David W.;Brown, Tiffany;Wolf, Michael S.
通讯作者：
Wolf, Michael S.
影响因子：
12.6
作者：
Choi, Debra T.;Kum, Hye-Chung;Singal, Amit G.
通讯作者：
Singal, Amit G.
DOI：
10.1097/meg.0000000000000404
发表时间：
2015-09-01
影响因子：
2.1
作者：
Del Poggio, Paolo;Olmi, Stefano;Stroffolini, Tommaso
通讯作者：
Stroffolini, Tommaso
影响因子：
13.5
作者：
Heimbach, Julie K.;Kulik, Laura M.;Marrero, Jorge A.
通讯作者：
Marrero, Jorge A.
影响因子：
6.7
作者：
Bucci, Laura;Garuti, Francesca;Trevisani, Franco
通讯作者：
Trevisani, Franco