Yuen M-F, Lai C-L
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Ann Oncol. 2003 Oct;14(10):1463-7. doi: 10.1093/annonc/mdg400.
The prognosis for patients with hepatocellular carcinoma (HCC) is poor by the time they present with symptoms. This review examines the usefulness of screening programs from the perspectives of survival benefit and of cost-effectiveness.
Articles were searched through Medline for screening, HCC, treatment and cost-effectiveness.
Both ultrasonography and alpha-fetoprotein testing have a low sensitivity for detecting HCC, although a combination of the two investigations can increase sensitivity. They remain the main screening methods because they are convenient, non-invasive and easily assessable. Though earlier studies fail to show improvement in patient management and survival by screening, more recent studies demonstrate that screening can increase the chance of curative treatment and, more importantly, improve survival even after the adjustment of lead-time bias. This is probably due to the improvement in medical treatment and technology. The cost per tumor detected for a region is inversely proportional to the tumor incidence of that region.
In countries with a low prevalence of HCC, screening for HCC is not cost-effective. But in countries with a high prevalence of HCC, especially when screening is directed at older patients with a high risk of HCC, screening programs for HCC become much more cost-effective.
肝细胞癌（HCC）患者出现症状时预后较差。本综述从生存获益和成本效益的角度探讨筛查项目的实用性。
通过医学文献数据库检索有关筛查、HCC、治疗及成本效益的文章。
超声检查和甲胎蛋白检测对HCC的检测敏感性均较低，尽管两者联合检查可提高敏感性。它们仍是主要的筛查方法，因为其方便、无创且易于评估。虽然早期研究未显示筛查能改善患者管理及生存情况，但近期研究表明，筛查可增加根治性治疗的机会，更重要的是，即使在调整领先时间偏倚后也能提高生存率。这可能归因于医疗和技术的进步。某地区每检测出一个肿瘤的成本与其肿瘤发病率成反比。
在HCC患病率较低的国家，HCC筛查不具有成本效益。但在HCC患病率较高的国家，尤其是当筛查针对HCC高危老年患者时，HCC筛查项目的成本效益则会显著提高。
