监测对埃及肝癌患者肿瘤分期和治疗决策的影响。
Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients.
出版信息
Hepatol Int. 2010 Mar 20;4(2):500-6. doi: 10.1007/s12072-010-9170-x.
PURPOSE
Egyptian hepatocellular carcinoma (HCC) patients present at advanced stages. We aimed to study the influence of surveillance versus non-surveillance on HCC staging and the potential therapeutic options.
METHODS
A retrospective study to evaluate the effect of surveillance on early detection of HCC among cirrhotic patients from 2003 to 2008. Patients examined every 6 months using ultrasound and α-fetoprotein (α-FP) (group A) and those diagnosed with those that present for the first time symptomatically or incidentally (group B). Groups were compared for α-FP level, tumour characteristics, severity of liver disease; tumour staging was evaluated by Okuda, CLIP and BCLC staging systems, in addition to the potential therapeutic options.
RESULTS
Group A comprised 122 HCC cases and group B 473. Surveillance improved HCC detection: at the stage of single nodule in 62.3% in group A versus 52.2% in group B, (P = 0.046) and reduced the percentage of HCC with portal vein thrombosis in 16.4 versus 33.8%, (P = 0.000) and the percentage of α-FP >400 ng/ml in 19.5 versus 32.6%, (P = 0.006) in groups A and B, respectively. Surveillance doubled the detection of HCC at early stage of BCLC (25.4 vs. 11.9% P = 0.000) and doubled the patients' chance for loco-regional ablation (12.3 vs. 5.9%, P = 0.015) and liver transplantation (10.7 vs. 3.2%, P = 0.001) in groups A and B, respectively.
CONCLUSION
HCC surveillance increases early detection of HCC and doubled the chances for curative options. Implementation of both HCC surveillance and cadaveric liver transplantation programs should be recommended in Egypt.
目的
埃及肝细胞癌 (HCC) 患者就诊时已处于晚期。我们旨在研究监测与非监测对 HCC 分期的影响，以及潜在的治疗选择。
方法
本研究为 2003 年至 2008 年间回顾性评估监测对肝硬化患者 HCC 早期检测影响的研究。每 6 个月使用超声和甲胎蛋白 (α-FP) 检查一次（A 组），那些首次出现症状或偶然发现 HCC 的患者（B 组）。比较两组的 AFP 水平、肿瘤特征、肝病严重程度；通过 Okuda、CLIP 和 BCLC 分期系统评估肿瘤分期，并评估潜在的治疗选择。
结果
A 组包括 122 例 HCC 病例，B 组包括 473 例 HCC 病例。监测提高了 HCC 的检出率：在 A 组中，单发结节期占 62.3%，而 B 组为 52.2%（P=0.046），且门静脉血栓形成的 HCC 比例分别从 16.4%降至 33.8%（P=0.000），AFP>400ng/ml 的比例分别从 19.5%降至 32.6%（P=0.006）。监测使 A 组和 B 组的 BCLC 早期 HCC 检出率分别增加了一倍（25.4%对 11.9%，P=0.000），使局部区域消融的机会分别增加了一倍（12.3%对 5.9%，P=0.015）和肝移植（10.7%对 3.2%，P=0.001）。
结论
HCC 监测增加了 HCC 的早期检出率，并使根治性治疗的机会增加了一倍。建议在埃及实施 HCC 监测和尸体供肝移植计划。
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