The Liver Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
Dig Dis Sci. 2010 Mar;55(3):826-35. doi: 10.1007/s10620-009-1059-y. Epub 2009 Dec 4.
Hepatocellular carcinoma (HCC) is a common malignancy in Asians with hepatitis B virus infection. HCC patients often present with poor liver function and large tumors resulting in rapid mortality. The impact of HCC surveillance and subsequent therapy on patient survival remain controversial.
We sought to determine if surveillance for HCC in a community-based clinic improve survival and, if so, identify factors that contribute to the benefit of early tumor detection.
From 1991 to 2008, alpha-fetoprotein and abdominal ultrasound examination were used as surveillance tests for HCC. The survival of HCC patients detected by surveillance was compared to patients who presented to the clinic with HCC (no surveillance). An adjusted lead-time bias interval was added to the survival time of patients who presented with HCC.
During this period, 26 patients with surveillance developed HCC while 52 patients presented with HCC. More surveillance patients had normal levels of alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase (p < 0.05-0.0001) and had tumors that were within Milan and University of California San Francisco (UCSF) criteria (p = 0.02-0.0001). The 1-, 3-, and 5-year survival rates were higher in surveillance patients and in those who received surgical or loco-regional therapies (p = 0.007-0.0001). On multivariate analysis, baseline independent factors predicting survival were single tumors (Hazard ratio [HR] 0.25, p = 0.0005), UCSF criteria (HR 0.29, p = 0.006), Child-Turcotte-Pugh class A (HR 0.45, p = 0.03), platelet counts per log(10) increase (HR 0.315, p = 0.04) and aspartate aminotransferase per log(10) increase (HR 5.7, p = 0.01).
Surveillance for HCC identified patients with smaller tumor burdens and more adequate liver function who were able to receive more definitive therapies. HCC surveillance improves survival and should be included as standard of care for patients with hepatitis B.
肝细胞癌（HCC）是乙型肝炎病毒感染亚洲人群中常见的恶性肿瘤。HCC 患者常伴有肝功能不良和大肿瘤，导致死亡率迅速上升。HCC 监测及其后续治疗对患者生存的影响仍存在争议。
我们旨在确定社区诊所的 HCC 监测是否能提高生存率，如果能，那么确定哪些因素有助于早期肿瘤检测的获益。
1991 年至 2008 年，甲胎蛋白和腹部超声检查被用作 HCC 的监测试验。通过监测发现的 HCC 患者的生存情况与就诊时出现 HCC（无监测）的患者进行比较。对就诊时出现 HCC 的患者的生存时间添加了一个调整后的领先时间偏倚间隔。
在此期间，26 例监测患者发生 HCC，52 例患者就诊时发现 HCC。更多的监测患者碱性磷酸酶、丙氨酸转氨酶和天冬氨酸转氨酶水平正常（p<0.05-0.0001），肿瘤符合米兰和加利福尼亚大学旧金山分校（UCSF）标准（p=0.02-0.0001）。监测患者和接受手术或局部区域治疗的患者的 1 年、3 年和 5 年生存率更高（p=0.007-0.0001）。多因素分析显示，预测生存的独立基线因素为单发肿瘤（风险比[HR]0.25，p=0.0005）、UCSF 标准（HR 0.29，p=0.006）、Child-Turcotte-Pugh 分级 A（HR 0.45，p=0.03）、血小板计数每对数增加（HR 0.315，p=0.04）和天冬氨酸转氨酶每对数增加（HR 5.7，p=0.01）。
HCC 监测可发现肿瘤负荷较小、肝功能较好的患者，从而能够接受更明确的治疗。HCC 监测可提高生存率，应作为乙型肝炎患者的标准治疗方法。
