RRSS Evaluate Completeness Liver Cancer Reporting Under New Clinical Guidelines

RRSS 根据新临床指南评估肝癌报告的完整性

• 批准号: 8351018
• 负责人: DEE WEST
• 金额: $ 3.75万
• 依托单位: PUBLIC HEALTH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8351018
• 关键词: Accounting; Adult; American; Asian Americans; Asians; Awareness; Biopsy; Blood Vessels; California; Cancer Etiology; Cancer Patient; Case Study; Cessation of life; Characteristics; Child; Chronic; Clinical; Clinical Practice Guideline; Clinical Practice Patterns; Databases; Diagnosis; Diagnostic; Ethnic Origin; Europe; Evaluation; Gender; Guidelines; Hepatitis B; Hepatitis C virus; High-Risk Cancer; Home environment; Hospital Registrar; Hospitals; Image; Incidence; Intervention; Liver diseases; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of liver; Medical Records; Pacific Island Americans; Paper; Pathology Report; Patients; Population; Positioning Attribute; Practice Guidelines; Primary carcinoma of the liver cells; Publications; Publishing; Race; Radiology Specialty; Recommendation; Records; Registries; Reporting; Research Training; Risk; Risk Factors; Role; Scientist; Screening procedure; Source; Staging; System; Testing; Ultrasonography; United States; X-Ray Computed Tomography; case finding; clinical practice; high risk; liver biopsy; liver transplantation; mortality; neoplasm registry; population based; programs; response; training project; trend

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer in both children and adults, accounting for 90% of all liver cancers. It is the third leading cause of cancer-related mortality worldwide and the incidence of HCC has been rising in the United States and Europe over the past decades. In the U.S., liver cancer is among the top 10 most common cancers with the highest incidence rates among Asian Americans. Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is by far the most important risk factor for liver cancer. Clinical practice guidelines for the diagnosis, staging and treatment of HCC did not exist in the U.S. until the 2005 publication of the practice guideline for the management of hepatocellular carcinoma developed by the American Association for the Study of Liver Diseases (AASLD). The guideline recommended the use of ultrasound, CT scan, and MRI for the diagnosis of HCC with typical features. Biopsy is considered unnecessary if the imaging tests show typical features of HCC. Biopsy is recommended only when the vascular profile on imaging is not characteristic of HCC. In its 2009 position paper, the AASLD reaffirmed its stance on the role of liver biopsy in diagnosing and treating HCC. Under these practice guidelines, many liver cancer patients in recent years either do not have pathology reports or are not hospitalized for treatment, which jeopardizes completeness of liver cancer reporting in the population-based cancer registry system that heavily relies on these means for routine case-finding. Surveillance for HCC is of particular importance in California which has a large Asian/Pacific Islander population at high risk for this cancer. A recent published analysis of cancer trends in California showed while incidence rates were highest among Asian/Pacific Islanders, there was an increase of liver cancer in all race/ethnicity and gender groups between 1988 and 2005. If HCC is under ascertained, and if that under ascertainment is increasing because of recent changes in diagnostic practice, then we may be underestimating the magnitude of the problem. California also is the home of the Asian American Network for Cancer Awareness, Research and Training (AANCART). A current AANCART project is to increase screening for Hepatitis B in high risk populations. Evaluation of this intervention is at risk if HCC is incompletely ascertained. Given that these clinical guidelines for liver cancer are rather recent and that they are recommendations rather than requirements, their impact on the completeness of liver cancer reporting may have not yet been obvious in cancer registry reports. An earlier evaluation of HCC reported that 51 out of 909 (6%) of HCC cases diagnosed between 2000 and 2007 were missed by both the hospital which had a unified record and the SEER registries. Most of the HCC cases missed by the hospital registry were diagnostically confirmed by radiology. Scientists recently conducted a limited linkage of 60 HCC patients seen in 2009 at the Liver Transplant Program with the registry database. They found no records in this database for 24 (40%) of these cases. The higher proportion of missing cases is likely because the hospital registrars in the previous study has access to the unified medical records for their patients, registrars in this study depend primarily on pathology reports for casefinding. PHI will further investigate these and other potential missing HCC cases and identify systematic inadequacies in the current registry case-finding and case-reporting mechanisms for liver cancer, in relation to the emerging clinical practice patterns of liver cancer.

肝细胞癌是儿童和成人最常见的原发性肝癌，占所有肝癌的90%。它是全球癌症相关死亡的第三大原因，在过去的几十年里，美国和欧洲的肝癌发病率一直在上升。在美国，肝癌是亚裔美国人中发病率最高的十大最常见癌症之一。慢性感染乙肝病毒(乙肝病毒)或丙型肝炎病毒(丙型肝炎病毒)是迄今为止最重要的肝癌危险因素。 直到2005年美国肝病研究协会(AASLD)发布了肝细胞癌治疗实践指南，美国才有了肝细胞癌诊断、分期和治疗的临床实践指南。该指南建议使用超声、CT扫描和MRI诊断具有典型特征的肝细胞癌。如果影像检查显示肝细胞癌的典型特征，活检被认为是不必要的。只有当影像上的血管轮廓不是肝细胞癌的特征时，才推荐活检。在2009年的立场文件中，AASLD重申了其对肝活检在诊断和治疗肝细胞癌中的作用的立场。根据这些实践指南，近年来许多肝癌患者要么没有病理报告，要么没有住院治疗，这危及以人群为基础的癌症登记系统中肝癌报告的完整性，该系统严重依赖这些手段进行常规病例发现。 在加利福尼亚州，对肝癌的监测尤其重要，因为加州有大量的亚太岛民，患有这种癌症的风险很高。最近发表的一项对加利福尼亚州癌症趋势的分析显示，虽然亚洲/太平洋岛民的发病率最高，但在1988年至2005年期间，所有种族/民族和性别群体的肝癌发病率都有所增加。如果肝细胞癌的确诊不足，如果由于最近诊断实践的变化而导致确诊不足的情况有所增加，那么我们可能低估了问题的严重性。加州也是亚裔美国人癌症意识、研究和培训网络(AANCART)的所在地。目前AANCART的一个项目是在高危人群中增加对乙肝的筛查。如果不能完全确定肝细胞癌，对这种干预措施的评估是有风险的。 鉴于这些肝癌临床指南是相当新的，而且它们是建议而不是要求，它们对肝癌报告完整性的影响在癌症登记报告中可能还不明显。早些时候对肝细胞癌的评估报告说，在2000年至2007年间诊断的909例肝细胞癌病例中，有51例(6%)被具有统一记录的医院和SEER登记机构遗漏。医院登记处漏掉的大多数肝细胞癌病例都是通过放射学确诊的。科学家最近对2009年在肝移植计划中发现的60名肝细胞癌患者与登记数据库进行了有限的联系。他们在这个数据库中找不到其中24例(40%)的记录。遗漏病例比例较高可能是因为前一项研究中的医院登记员可以获得其患者的统一病历，而本研究中的登记员主要依靠病理报告来发现病例。PHI将进一步调查这些和其他可能丢失的肝癌病例，并找出与新出现的肝癌临床实践模式有关的现有肝癌登记病例发现和病例报告机制的系统性不足之处。