Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Hepatol. 2012 Jun;56(6):1324-9. doi: 10.1016/j.jhep.2011.12.027. Epub 2012 Feb 6.
BACKGROUND & AIMS: The value of chest computed tomography (CT) and bone scan (BS) during initial staging workup for hepatocellular carcinoma (HCC) patients has not been evaluated in a large patient group.
A prospective cohort of 381 patients who were initially diagnosed as having HCC at our institution between 2008 and 2010 was enrolled. We evaluated whether chest CT and BS could affect Barcelona Clinic Liver Cancer (BCLC) and Union for International Cancer Control (UICC) (7th) staging, compared with liver dynamic CT (LDCT) and chest X-ray.
Abnormal findings on chest CT and BS were observed in 59.6% and 52.8% of 381 patients, respectively. Thirty and eight patients, respectively, had truly metastatic intrathoracic and bone lesions, with 19 (49.8%) and 7 (87.5%) exhibiting the same lesions on LDCT or chest X-ray. Of the 381 patients, 60 (15.7%), 134 (35.2%), 61 (16.0%), 119 (31.2%), and 7 (1.8%) had BCLC stages 0, A, B, C, and D, respectively; 176 (46.2%), 83 (21.8%), 41 (10.8%), 39 (10.2%), 0 (0%), 8 (2.1%), and 34 (8.9%) had UICC stages I, II, IIIA, IIIB, IIIC, IVA, and IVB, respectively before chest CT and BS. Only three of 381 patients showed a shift in BCLC stage [B→C (3/61, 4.9%)]. Chest CT and BS revealed additional metastases in only 1.1%, 14.0%, and 5.6% of patients with UICC stage T2, T3a, and T3b, respectively.
Chest CT and BS do not provide additional information on metastasis in HCC patients with BCLC 0, A, C, or D stages, and UICC T1 or T4 stages on LDCT.
在大规模患者群体中，尚未对胸部计算机断层扫描（CT）和骨扫描（BS）在肝细胞癌（HCC）患者初始分期检查中的价值进行评估。
本研究纳入了 2008 年至 2010 年期间在我院初诊为 HCC 的 381 例患者的前瞻性队列。我们评估了与肝脏动态 CT（LDCT）和胸部 X 射线相比，胸部 CT 和 BS 是否会影响巴塞罗那临床肝癌（BCLC）和国际抗癌联盟（UICC）（第 7 版）分期。
381 例患者中分别有 59.6%和 52.8%的患者胸部 CT 和 BS 检查结果异常。分别有 30 例和 8 例患者存在真正的胸内和骨转移灶，其中 19 例（49.8%）和 7 例（87.5%）在 LDCT 或胸部 X 射线检查中存在相同的病灶。381 例患者中，分别有 60 例（15.7%）、134 例（35.2%）、61 例（16.0%）、119 例（31.2%）和 7 例（1.8%）为 BCLC 分期 0、A、B、C 和 D；176 例（46.2%）、83 例（21.8%）、41 例（10.8%）、39 例（10.2%）、0 例（0%）、8 例（2.1%）和 34 例（8.9%）为 UICC 分期 I、II、IIIA、IIIB、IIIC、IVA 和 IVB。在进行胸部 CT 和 BS 检查之前，仅 381 例患者中的 3 例（61 例中的 3 例）出现 BCLC 分期转移[B→C（3/61，4.9%）]。胸部 CT 和 BS 仅在分别为 UICC 分期 T2、T3a 和 T3b 的患者中发现了 1.1%、14.0%和 5.6%的患者出现额外转移。
在 BCLC 分期为 0、A、C 或 D 以及 UICC 分期为 T1 或 T4 的 HCC 患者中，胸部 CT 和 BS 并未提供关于转移的额外信息。
