Youk Chung Mee, Choi Moon Seok, Paik Seung Woon, Ahn Byeong Hoon, Lee Joon Hyeok, Koh Kwang Cheol, Yoo Byung Chul, Rhee Jong Chul
Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Taehan Kan Hakhoe Chi. 2003 Jun;9(2):116-23.
BACKGROUND/AIMS: Screening for hepatocellular carcinoma (HCC) is a common practice in the endemic countries but its exact role has not been fully investigated. The purpose of this study was to determine whether screening can achieve early diagnosis and survival benefits.
All HCC patients diagnosed at our hospital (September 1994 April 2000) were enrolled; They were divided into two groups; a surveilled group screened with alpha-fetoprotein (AFP) and ultrasound (US) for longer than 6 months before diagnosis and a non-surveilled group. We compared the tumor size, portal vein thrombosis, and stage at initial diagnosis and survival rate between the two groups.
A total of 247 patients were enrolled. 64 were in the surveilled group and 183 were in the non-surveilled group. The tumor size at initial diagnosis in the surveilled group was smaller than in the non-surveilled group (2.6 +/- 2.0 cm vs. 5.7 +/- 4.1 cm, p<0.05). The percentages of patients with stage I, II, III, and IV were 42.2%, 20.3%, 14.1%, 23.4% in the surveilled group and 8.7%, 19.7%, 36.6%, 35.0% in the non-surveilled group. A significantly higher proportion in the surveilled group had earlier stage compared with the non-surveilled group (p<0.05). Portal vein thrombosis in the surveilled group was noticed as significantly less than in the non-surveilled group (9.4% vs. 26.8%, p<0.05). Among Child-Pugh A patients, the cumulative survival rate in the surveilled group was significantly higher than in the non-surveilled group (1 year; 91.4% vs. 70.7%, 2 year; 71.5% vs. 59.9%, p<0.05).
Screening with AFP and US is a useful tool for early diagnosis of HCC, especially with improved survival in Child-Pugh A patients.
背景/目的：在肝癌流行国家，肝细胞癌（HCC）筛查是一种常见做法，但其确切作用尚未得到充分研究。本研究的目的是确定筛查是否能实现早期诊断并带来生存获益。
纳入我院（1994年9月至2000年4月）诊断的所有HCC患者；将他们分为两组，一组为监测组，在诊断前接受甲胎蛋白（AFP）和超声（US）筛查超过6个月，另一组为非监测组。我们比较了两组患者初诊时的肿瘤大小、门静脉血栓形成情况、分期及生存率。
共纳入247例患者。监测组64例，非监测组183例。监测组初诊时肿瘤大小小于非监测组（2.6±2.0cm对5.7±4.1cm，p<0.05）。监测组Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期患者的百分比分别为42.2%、20.3%、14.1%、23.4%，非监测组分别为8.7%、19.7%、36.6%、35.0%。与非监测组相比，监测组早期分期的患者比例显著更高（p<0.05）。监测组门静脉血栓形成情况明显少于非监测组（9.4%对26.8%，p<0.05）。在Child-Pugh A级患者中，监测组的累积生存率显著高于非监测组（1年：91.4%对70.7%，2年：71.5%对59.9%，p<0.05）。
AFP和US筛查是早期诊断HCC的有用工具，尤其是可提高Child-Pugh A级患者的生存率。
