Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA 94143-0538, USA.
Clin Transplant. 2011 Mar-Apr;25(2):283-91. doi: 10.1111/j.1399-0012.2010.01212.x.
The effectiveness of screening and treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) remains undefined. Our aim was to evaluate the potential cost-effectiveness of screening for recurrent HCC after LT. We constructed a Markov model of the natural history after LT for HCC. We superimposed screening with computed tomography, alpha-fetoprotein, and chest X-ray every six months for 1-5 yr after LT, with resection for treatable recurrence. Screening only those whose explant pathology exceeded Milan Criteria (MC) for two yr cost $ 138,000/life-yr gained, and the incremental cost of screening all patients was $ 340,000/life-yr gained. Screening for longer than two yr incurred progressively higher incremental costs/life-yr gained. The most critical variable in sensitivity analyses was the survival benefit of finding a resectable recurrence. With the most favorable assumptions for a two-yr screening duration, screening those whose explant pathology exceeded MC cost $ 91,000/life-yr gained. In conclusion, screening for HCC recurrence after LT would probably yield most of its benefit in the first two yr, but at a relatively high cost/life-yr gained. Screening for two yr in only those whose explant pathology exceeds MC may be relatively cost-effective depending on the survival benefit of resection.
肝移植（LT）后复发性肝细胞癌（HCC）的筛查和治疗效果仍未确定。我们的目的是评估 LT 后复发性 HCC 筛查的潜在成本效益。我们构建了 HCC LT 后自然史的马尔可夫模型。我们将 CT、甲胎蛋白和胸部 X 线检查每 6 个月进行一次，对 LT 后 1-5 年进行筛查，对可治疗的复发进行切除。仅对移植组织病理学超过米兰标准（MC）2 年的患者进行筛查，每获得 1 个生命年的成本为 138000 美元，对所有患者进行筛查的增量成本为 340000 美元。筛查时间超过 2 年，每获得 1 个生命年的增量成本将逐渐增加。敏感性分析中最关键的变量是发现可切除复发的生存获益。在最有利于 2 年筛查时间的假设下，对移植组织病理学超过 MC 的患者进行筛查，每获得 1 个生命年的成本为 91000 美元。总之，LT 后 HCC 复发的筛查可能在最初 2 年内获得大部分收益，但成本效益相对较高。仅对移植组织病理学超过 MC 的患者进行 2 年的筛查，可能具有成本效益，具体取决于切除的生存获益。
