Giannini E, Arzani L, Borro P, Botta F, Fasoli A, Risso D, Celle G, Testa R
Department of Internal Medicine, University of Genoa, Italy.
Hepatogastroenterology. 2000 Sep-Oct;47(35):1395-8.
BACKGROUND/AIMS: Cirrhotic patients with hepatitis C virus infection are a group at higher risk for hepatocellular carcinoma. Conventional screening programs detect only few early hepatocellular carcinomas that are eligible for radical treatment. Our aim was to compare characteristics of patients, modality of treatment, and outcome in anti-HCV positive cirrhotics with hepatocellular carcinoma diagnosed during follow-up, or incidentally.
Sixty-one hepatocellular carcinomas were consecutively diagnosed in cirrhotic anti-HCV patients from 1993-1998 among which 34 during biannual ultrasonographic-biochemical follow-up and the others incidentally. Child-Pugh's score, alpha-fetoprotein levels, uni- or multifocality of the tumor, and treatment and survival of the patients were then analyzed on the basis of modality of diagnosis.
Surgical treatment was feasible only in a minority of patients. Radical and palliative treatment was more frequent among patients with HCC diagnosed during follow-up. Child-Pugh's score was lower in these patients, moreover their survival rate was better. Analysis of survival of patients treated with the same procedure and grouped by modality of diagnosis did not demonstrate any differences. Regression analysis showed that patients with a lower Child-Pugh's score, one nodule, with a tumor diagnosed during follow-up and who were treated had a better survival rate.
In our population surveillance did not detect a higher percentage of curable HCC. Nevertheless the results of palliative treatment and of curative treatment overlapped. Overall better outcome was observed in patients with preserved liver function whatever the treatment. Surveillance allowed us to diagnose HCC in patients with these characteristics thus leading to an improved survival rate.
背景/目的：丙型肝炎病毒感染的肝硬化患者是肝细胞癌的高危人群。传统的筛查项目仅能检测出少数适合根治性治疗的早期肝细胞癌。我们的目的是比较随访期间诊断出的或偶然发现的抗丙型肝炎病毒阳性肝硬化合并肝细胞癌患者的特征、治疗方式及预后。
1993年至1998年期间，对连续诊断出的61例抗丙型肝炎病毒肝硬化患者的肝细胞癌进行研究，其中34例是在半年一次的超声-生化随访中发现的，其余为偶然发现。然后根据诊断方式分析患者的Child-Pugh评分、甲胎蛋白水平、肿瘤的单灶或多灶性以及患者的治疗和生存情况。
仅少数患者可行手术治疗。在随访期间诊断出肝细胞癌的患者中，根治性和姑息性治疗更为常见。这些患者的Child-Pugh评分较低，而且生存率较好。对接受相同治疗方法并按诊断方式分组的患者进行生存分析，未发现任何差异。回归分析表明，Child-Pugh评分较低、肿瘤为单结节、在随访期间诊断出且接受治疗的患者生存率较高。
在我们的研究人群中，监测并未发现可治愈肝细胞癌的比例更高。然而，姑息性治疗和根治性治疗的结果有重叠。无论采用何种治疗方法，肝功能良好的患者总体预后较好。监测使我们能够诊断出具有这些特征的肝细胞癌患者，从而提高了生存率。
