Henrion Jean, Libon Ernest, De Maeght Stéphane, Deltenre Pierre, Schapira Michaël, Ghilain Jean-Michel, Maisin Jean-Marc, Heller Francis R
Unité d'Hépato-Gastroentérologie, Centre Hospitalier de Jolimont-Lobbes, Belgique.
Gastroenterol Clin Biol. 2003 May;27(5):534-9.
To assess the feasibility and efficiency of the screening for hepatocarcinoma in a cohort of cirrhoseis mainly of alcoholic origin.
293 patients with cirrhosis, among them 186 (63.5%) from alcoholic origin, were included in a surveillance programme for hepatocarcinoma by carrying out liver ultrasonography and alpha-foetoprotein dosage every 6 months. Results were analyzed with a mean follow-up of 60 months. Seventeen hepatocarcinoma discovered through the surveillance programme ("screened HCC") were compared with 40 hepatocarcinoma discovered outside the surveillance programme during the same period ("incidental HCC").
The alcoholic origin of the cirrhosis was a predictive factor of poor compliance to the surveillance programme. Among the 186 patients with alcoholic cirrhosis, 129 (69%) were lost during the surveillance programme due to lack of compliance (97 cases) or death (32 cases). By comparison, among the 65 patients with hepatitis C-related cirrhosis, 18 were lost by lack of compliance (11 cases) or death (7 cases) (P<0.001). Moreover, sustained or relapsing alcohol abuse after inclusion in the surveillance programme were also related to the quality of the compliance. Seventeen hepatocarcinoma were discovered through the surveillance giving an annual incidence of 2% for the emergence of hepatocarcinoma. The comparison between screened (n=17) and incidental (n=40) hepatocarcinoma showed that screened HCC were more often asymptomatic (P<0.01), were more often a solitary nodule less than 5 cms (P<0.001) and underwent more often curative treatment (P=0.02). However, the survival between screened and incidental hepatocarcinoma was not different.
Screening for hepatocarcinoma in patients with alcoholic cirrhosis is a difficult task due to poor compliance and early death. According to our results, a surveillance every 6 months is sufficient to detect early lesions accessible to curative treatment by surgical resection or transcutaneous ablation.
评估在主要为酒精性肝硬化患者队列中筛查肝癌的可行性和效率。
293例肝硬化患者被纳入肝癌监测项目，其中186例（63.5%）为酒精性肝硬化，每6个月进行肝脏超声检查和甲胎蛋白定量检测。对结果进行分析，平均随访60个月。将通过监测项目发现的17例肝癌（“筛查出的肝癌”）与同期在监测项目外发现的40例肝癌（“偶然发现的肝癌”）进行比较。
肝硬化的酒精性病因是监测项目依从性差的一个预测因素。在186例酒精性肝硬化患者中，129例（69%）在监测项目期间因依从性差（97例）或死亡（32例）而失访。相比之下，在65例丙型肝炎相关性肝硬化患者中，18例因依从性差（11例）或死亡（7例）而失访（P<0.001）。此外，纳入监测项目后持续或复发性酒精滥用也与依从性质量有关。通过监测发现了17例肝癌，肝癌的年发病率为2%。筛查出的肝癌（n=17）与偶然发现的肝癌（n=40）的比较表明，筛查出的肝癌更常无症状（P<0.01），更常为单个小于5厘米的结节（P<0.001），且更常接受根治性治疗（P=0.02）。然而，筛查出的肝癌与偶然发现的肝癌的生存率并无差异。
由于依从性差和早期死亡，对酒精性肝硬化患者进行肝癌筛查是一项艰巨的任务。根据我们的结果，每6个月进行一次监测足以检测出可通过手术切除或经皮消融进行根治性治疗的早期病变。
Zotero 插件