Mok Tony S K, Yeo Winnie, Yu Simon, Lai Paul, Chan Henry L Y, Chan Anthony T C, Lau Joseph W Y, Wong Herman, Leung Nancy, Hui Edwin P, Sung Joseph, Koh Jane, Mo Frankie, Zee Benny, Johnson Philip J
Department of Clinical Oncology, Prince of Wales Hospital, School of Public Health, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
J Clin Oncol. 2005 Nov 1;23(31):8041-7. doi: 10.1200/JCO.2005.01.9927.
To study the incidence and treatment outcomes of hepatocellular carcinoma (HCC) detected in an intensive surveillance program (ISP) of hepatitis B virus (HBV) carriers.
We screened 1,018 HBV carriers by serum alpha-fetoprotein (AFP) measurement and abdominal ultrasonography (AUS). Patients with an abnormal AFP level or AUS result were enrolled in an ISP that included Lipiodol computed tomography followed by AFP measurement/AUS every 3 months for 2 years and then every 6 months thereafter. The rest were on routine surveillance for 2 years.
A total of 9,849 serum AFP measurements and 3,053 AUSs were performed. After a median follow-up of 4.12 years, we diagnosed 24 HCCs among 78 patients with abnormal screening test results at enrollment (group A); 23 HCCs among 93 patients with only abnormal surveillance test results during follow-up (group B); and nine HCCs among 847 patients with 2 years of normal surveillance (group C). Annual incidence of HCC in the ISP was 760.2 (95% CI, 538.4 to 1,073.7) per 100,000. Mean tumor sizes were 3.02, 2.91, and 4.82 cm in groups A, B, and C, respectively (P = .01). Tumor resection rate of the ISP was 36.2%, although another 29.8% of the patients were eligible for locoregional ablative therapy.
This study illustrated that a high incidence of relatively small HCCs may be detected by using intensive surveillance of high-risk HBV carriers. However, the surgical resection rate was low, and we were not able to demonstrate clinical benefit with the early detection. Future surveillance studies should consider incorporation of therapy aimed at long-term control of small-sized tumors.
研究在乙型肝炎病毒（HBV）携带者强化监测项目（ISP）中检测到的肝细胞癌（HCC）的发病率及治疗结果。
我们通过血清甲胎蛋白（AFP）检测及腹部超声检查（AUS）对1018名HBV携带者进行了筛查。AFP水平异常或AUS结果异常的患者被纳入ISP，该项目包括碘油计算机断层扫描，随后每3个月进行AFP检测/AUS检查，持续2年，之后每6个月检查一次。其余患者接受为期2年的常规监测。
共进行了9849次血清AFP检测和3053次AUS检查。中位随访4.12年后，我们在入组时筛查试验结果异常的78例患者中诊断出24例HCC（A组）；在随访期间仅监测试验结果异常的93例患者中诊断出23例HCC（B组）；在接受2年正常监测的847例患者中诊断出9例HCC（C组）。ISP中HCC的年发病率为每10万人760.2（95%可信区间，538.4至1073.7）。A组、B组和C组的平均肿瘤大小分别为3.02、2.91和4.82 cm（P = 0.01）。ISP的肿瘤切除率为36.2%，尽管另有29.8%的患者适合局部消融治疗。
本研究表明，通过对高危HBV携带者进行强化监测，可能检测到相对较小的HCC的高发病率。然而，手术切除率较低，且我们未能证明早期检测具有临床益处。未来的监测研究应考虑纳入旨在长期控制小肿瘤的治疗方法。
