Fasani P, Sangiovanni A, De Fazio C, Borzio M, Bruno S, Ronchi G, Del Ninno E, Colombo M
FIRC-University of Milan Liver Cancer Unit, Department of Internal Medicine, IRCCS Maggiore Hospital, Milan, Italy.
Hepatology. 1999 Jun;29(6):1704-7. doi: 10.1002/hep.510290604.
To see whether or not there is an association between the cause of cirrhosis and the number of hepatocellular carcinoma (HCC) nodules, we analyzed 178 consecutive patients in whom HCC was detected during a prospective screening by abdominal ultrasound (US). The relevant information was obtained from the database of the screening programs operating at four hospitals in the Milan area. One hundred twenty-nine (72%) patients had a single tumor nodule detected by US and 49 (28%) patients had multinodular disease. Ninety-eight (55%) patients had normal serum values of alpha-fetoprotein (AFP). Tumor staging with biphasic computed tomography (CT) scan or hepatic arteriography with lipiodol revealed that 101 (57%) patients had single tumor nodules and 77 (43%) patients had more than one HCC nodule. After staging, multinodular HCC was more common in patients with multiple risk factors than in the hepatitis C virus (HCV) carriers (56% vs. 38%, P =.05). Interestingly, single tumors were as common in the 126 patients undergoing 6-month interval screening as in the 52 patients who were studied at yearly intervals. The former patients, however, had more small tumors than the latter ones (91% vs. 74%, P =.04). The 22 patients who were alcohol abusers had normal levels of serum AFP more often than the hepatitis B virus (HBV) or HCV carriers or those with multiple risk factors (86% vs. 57%, P <.04; vs. 47%, P <.002; vs. 52%, P <.006, respectively). We concluded that multinodular HCC was underdetected by real time US; it prevailed among patients with multiple risk factors. In these patients, screening with US exams every 6 months may be inadequate for early detection of liver cancer.
为了探究肝硬化病因与肝细胞癌（HCC）结节数量之间是否存在关联，我们分析了178例在腹部超声（US）前瞻性筛查中检测出HCC的连续患者。相关信息取自米兰地区四家医院筛查项目的数据库。129例（72%）患者经超声检测发现单个肿瘤结节，49例（28%）患者患有多结节疾病。98例（55%）患者血清甲胎蛋白（AFP）值正常。双期计算机断层扫描（CT）或碘油肝动脉造影的肿瘤分期显示，101例（57%）患者有单个肿瘤结节，77例（43%）患者有不止一个HCC结节。分期后，多结节HCC在具有多种危险因素的患者中比在丙型肝炎病毒（HCV）携带者中更常见（56%对38%，P = 0.05）。有趣的是，在每6个月进行一次间隔筛查的126例患者中，单个肿瘤的情况与每年进行一次研究的52例患者中一样常见。然而，前者的小肿瘤比后者更多（91%对74%，P = 0.04）。22例酗酒患者血清AFP水平正常的情况比乙型肝炎病毒（HBV）或HCV携带者或具有多种危险因素的患者更常见（分别为86%对57%，P < 0.04；对47%，P < 0.002；对52%，P < 0.006）。我们得出结论，实时超声对多结节HCC检测不足；它在具有多种危险因素的患者中占主导。在这些患者中，每6个月进行一次超声检查筛查可能不足以早期发现肝癌。
