Dipartimento di Medicina Clinica, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Italy.
J Hepatol. 2010 Aug;53(2):291-7. doi: 10.1016/j.jhep.2010.03.010. Epub 2010 Apr 27.
BACKGROUND & AIMS: The current guidelines recommend the surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on liver ultrasonography repetition at either 6 or 12 month intervals, since there is no compelling evidence of superiority of the more stringent program. This study aimed at comparing cancer stage, treatment applicability, and survival between patients on semiannual or annual surveillance.
We analyzed the clinical records of 649 HCC patients in Child-Pugh class A or B, observed in ITA.LI.CA centers. HCC was detected in 510 patients submitted to semiannual surveillance (Group 1) and in 139 submitted to annual surveillance (Group 2). In Group 1 the survival was presented as observed and corrected for the lead time.
The cancer stage was less severe in Group 1 than in Group 2 (p<0.001), with more single tiny (2 cm) and less advanced tumors. Treatment applicability was improved by the semiannual program (p=0.020). The median observed survival was 45 months (95% CI 40.0-50.0) in Group 1 and 30 months (95% CI 24.0-36.0) in Group 2 (p=0.001). The median corrected survival of Group 1 was 40.3 months (95% CI 34.9-45.7) (p=0.028 with respect to the observed survival of Group 2). Age, platelet count, alpha-fetoprotein, Child-Pugh class, cancer stage, and hepatocellular carcinoma treatment were independent prognostic factors.
Semiannual surveillance increases the detection rate of very early hepatocellular carcinomas and reduces the number of advanced tumors as compared to the annual program. This translates into a greater applicability of effective treatments and into a better prognosis.
目前的指南建议对肝硬化患者进行监测，以便早期诊断肝细胞癌（HCC），根据肝脏超声检查的重复时间，间隔为 6 或 12 个月，因为没有强有力的证据表明更严格的方案具有优势。本研究旨在比较半年或每年监测的患者的癌症分期、治疗适用性和生存率。
我们分析了在 ITA.LI.CA 中心观察到的 A 级或 B 级 Child-Pugh 肝硬化患者的临床记录。在 510 名接受半年监测（第 1 组）和 139 名接受每年监测（第 2 组）的 HCC 患者中检测到 HCC。在第 1 组中，生存表现为观察到的，并校正了领先时间。
第 1 组的癌症分期比第 2 组轻（p<0.001），单发性微小（2 cm）肿瘤更多，进展性肿瘤更少。半年度方案提高了治疗适用性（p=0.020）。第 1 组的中位观察生存率为 45 个月（95%CI 40.0-50.0），第 2 组为 30 个月（95%CI 24.0-36.0）（p=0.001）。第 1 组的中位校正生存时间为 40.3 个月（95%CI 34.9-45.7）（与第 2 组的观察生存时间相比，p=0.028）。年龄、血小板计数、甲胎蛋白、Child-Pugh 分级、癌症分期和 HCC 治疗是独立的预后因素。
与年度方案相比，半年监测增加了对非常早期 HCC 的检出率，并减少了晚期肿瘤的数量。这转化为更有效的治疗方法的适用性更高，预后更好。
