Trevisani Franco, De Notariis Stefania, Rapaccini Gianludovico, Farinati Fabio, Benvegnù Luisa, Zoli Marco, Grazi Gian Luca, Del Poggio Paolo, Di NolfoMariaAnna, Bernardi Mauro
Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Semeiotica Medica, Università di Bologna, Italy.
Am J Gastroenterol. 2002 Mar;97(3):734-44. doi: 10.1111/j.1572-0241.2002.05557.x.
Surveillance of cirrhotic patients for early detection of hepatocellular carcinoma, based on ultrasonography and alpha1-fetoprotein determination, is a recommended practice. However, it has not been proved that this procedure can improve patient survival.
We conducted a multicenter retrospective study on 1051 consecutive patients with hepatocellular carcinoma. The criteria for eligibility were presence of underlying cirrhosis, and description of cancer stage and modalities of its diagnosis. Among 821 patients fulfilling these criteria, the tumor was detected during semiannual surveillance in 215 individuals (group 1), during annual surveillance in 155 (group 2), and as a result of symptoms or incidentally in 451 (group 3). Survival of patients under surveillance was corrected for lead time.
Cancer stage was similar in groups 1 and 2 and was less advanced than in group 3 (p < 0.001). The frequency of ablative treatments or chemoembolization was similar in groups 1 and 2 and was greater than in group 3 (p < 0.001). Both surveillance programs doubled the prevalence of potential candidates for liver transplantation (68.5% and 62.5%) with respect to group 3 (32.3%, p < 0.001). However, only 15 patients underwent transplantation. In groups 1 and 2, the 5-yr survival was equivalent and was greater than in group 3 (p < 0.001). By segregating patients according to severity of cirrhosis, the benefit was confined to compensated cirrhosis (adjusted relative risk of death for patients under surveillance: 0.59 [95% CI = 0.45-0.78]).
Semiannual and annual surveillance equally improve the survival of cirrhotic patients with hepatocellular carcinoma and greatly increase the amenability rate to liver transplantation. When access to liver transplantation is limited, this benefit is restricted to patients with a good cirrhosis-related prognosis.
基于超声检查和甲胎蛋白测定对肝硬化患者进行监测以早期发现肝细胞癌，这是一种推荐的做法。然而，尚未证明该程序能提高患者生存率。
我们对1051例连续性肝细胞癌患者进行了一项多中心回顾性研究。纳入标准为存在潜在肝硬化，以及癌症分期描述及其诊断方式。在符合这些标准的821例患者中，215例（第1组）在半年一次的监测期间发现肿瘤，155例（第2组）在年度监测期间发现肿瘤，451例（第3组）因出现症状或偶然发现肿瘤。对接受监测患者的生存情况进行了提前期校正。
第1组和第2组的癌症分期相似，且比第3组的分期更早（p<0.001）。第1组和第2组的消融治疗或化疗栓塞频率相似，且高于第3组（p<0.001）。与第3组（32.3%，p<0.001）相比，两种监测方案均使肝移植潜在候选者的比例增加了一倍（分别为68.5%和62.5%）。然而，只有15例患者接受了移植。第1组和第2组的5年生存率相当，且高于第3组（p<0.001）。根据肝硬化严重程度对患者进行分类后，获益仅限于代偿期肝硬化患者（接受监测患者的校正死亡相对风险：0.59[95%置信区间=0.45-0.78]）。
半年一次和一年一次的监测同样能提高肝硬化合并肝细胞癌患者的生存率，并大大提高肝移植的可接受率。当肝移植机会有限时，这种获益仅限于肝硬化相关预后良好的患者。
