The Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA.
Ann Intern Med. 2011 Jan 18;154(2):85-93. doi: 10.7326/0003-4819-154-2-201101180-00006.
Surveillance for hepatocellular carcinoma (HCC) is recommended for patients with hepatitis C virus (HCV) infection and cirrhosis. However, whether surveillance is being done as recommended is unknown.
To examine the prevalence and determinants of HCC surveillance among HCV-infected patients with cirrhosis in Veterans Affairs (VA) health care facilities in the United States.
Retrospective cohort study of HCV-infected patients using data obtained from the national VA Hepatitis C Clinical Case Registry.
128 VA medical centers.
HCV-infected patients with cirrhosis diagnosed between fiscal years 1998 and 2005.
Abdominal ultrasonography and measurement of α-fetoprotein for HCC surveillance were identified from administrative data by using a previously validated algorithm. Patients were categorized as having routine (tests done during at least 2 consecutive years in the 4 years after cirrhosis diagnosis), inconsistent (at least 1 test, but not routine), or no surveillance in the 4 years after cirrhosis diagnosis. Predictors of surveillance were identified by using hierarchical random-effects regression.
126 670 patients with HCV were identified; 13 002 (10.1%) had cirrhosis. Approximately 42.0% of patients with cirrhosis received 1 or more HCC surveillance tests within the first year after the cirrhosis index date; however, a decline in receipt of surveillance was observed in the following 2 to 4 years. Among patients with cirrhosis and at least 2 years of follow-up, routine surveillance occurred in 12.0%, inconsistent surveillance in 58.5%, and no surveillance in 29.5%. Lower medical and psychological comorbid conditions, presence of varices, and the absence of decompensated liver disease were associated with a higher likelihood of receiving routine surveillance.
Hepatocellular carcinoma surveillance tests were indirectly identified from registry data. Physician recommendations could not be captured.
Few HCV-infected veterans with cirrhosis received routine HCC surveillance. New strategies are needed to improve the implementation of HCC surveillance in clinical practice.
Houston Veterans Affairs Health Services Research and Development Center of Excellence and the National Cancer Institute.
对于患有丙型肝炎病毒 (HCV) 感染和肝硬化的患者，建议进行肝细胞癌 (HCC) 监测。但是，尚不清楚是否按照建议进行监测。
在美国退伍军人事务部 (VA) 医疗保健机构中，检查 HCV 感染合并肝硬化患者 HCC 监测的流行率和决定因素。
使用从全国 VA 丙型肝炎临床病例登记处获得的数据，对 HCV 感染患者进行回顾性队列研究。
128 家 VA 医疗中心。
1998 年至 2005 年间诊断为 HCV 感染合并肝硬化的患者。
通过使用先前验证的算法，从行政数据中确定 HCC 监测的腹部超声检查和甲胎蛋白测量。根据肝硬化诊断后 4 年内是否进行了常规 (连续 2 年以上进行了检查) 、不一致 (至少进行了 1 次检查，但未进行常规检查) 或无监测，将患者分为 3 组。通过分层随机效应回归确定监测的预测因素。
共确定了 126670 名 HCV 患者；其中 13002 名 (10.1%) 患有肝硬化。大约 42.0%的肝硬化患者在肝硬化指数日期后的第一年接受了 1 次或多次 HCC 监测检查；但是，在随后的 2 至 4 年内，接受监测的比例下降。在有肝硬化且随访至少 2 年的患者中，常规监测的比例为 12.0%，不一致监测的比例为 58.5%，无监测的比例为 29.5%。较低的医疗和心理合并症、存在静脉曲张以及无肝功能失代偿与更有可能进行常规监测相关。
肝细胞癌监测检查是从登记处数据中间接确定的。无法捕获医生的建议。
患有肝硬化的 HCV 感染退伍军人中，很少有人接受常规 HCC 监测。需要新的策略来改善 HCC 监测在临床实践中的实施。
休斯顿退伍军人事务部卫生服务研究与发展卓越中心和美国国家癌症研究所。
