Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Liver Int. 2015 Jul;35(7):1862-71. doi: 10.1111/liv.12764. Epub 2015 Jan 20.
BACKGROUND & AIMS: Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended in clinical guidelines. In real-life management, surveillance rates below 20% have been reported from the United States. We aimed to determine the use of HCC-surveillance in patients diagnosed with HCC in a European setting, and to identify the reasons for surveillance failures.
Age, gender, tumour characteristics, BCLC classification, Child-Pugh stage, pre-existing liver disease, treatment, survival, frequency of HCC surveillance and reasons for surveillance failures were retrospectively determined in 616 patients diagnosed with HCC at Karolinska University Hospital 2005-2012.
Hepatitis C, alcoholic liver disease and non-alcoholic fatty liver disease (NAFLD) were the most common diagnoses. The proportion of HCC patients diagnosed through surveillance was 22%. In 35% of cases, surveillance was missed due to doctor's failure to order surveillance or to diagnose the underlying liver disease. Diagnosis of NAFLD or alcoholic liver disease increased the risk of not receiving surveillance more than two-fold. Undiagnosed liver disease was most common in NAFLD patients. Patients who underwent surveillance had smaller tumours, more frequently received curative treatment, and had better survival compared to those in whom surveillance was indicated but missed.
In a European setting, only 22% of HCCs were diagnosed by surveillance, and in more than one-third of cases, surveillance was indicated but missed. NAFLD and alcoholic liver disease were associated with deficient surveillance. Survival was significantly better in patients who underwent surveillance compared with those in whom surveillance was missed although indicated.
临床指南建议对肝硬化患者进行肝细胞癌（HCC）监测。但在美国，实际管理中监测率低于 20%。我们旨在确定在欧洲环境中 HCC 患者的 HCC 监测使用情况，并确定监测失败的原因。
回顾性确定了 2005 年至 2012 年在卡罗林斯卡大学医院诊断为 HCC 的 616 例患者的年龄、性别、肿瘤特征、BCLC 分类、Child-Pugh 分期、原有肝脏疾病、治疗、生存、HCC 监测频率和监测失败的原因。
丙型肝炎、酒精性肝病和非酒精性脂肪性肝病（NAFLD）是最常见的诊断。通过监测诊断 HCC 的患者比例为 22%。在 35%的情况下，由于医生未下达监测或诊断潜在肝病的医嘱，导致监测失败。诊断为 NAFLD 或酒精性肝病使未接受监测的风险增加两倍以上。未确诊的肝病在 NAFLD 患者中最为常见。与应接受监测但漏诊的患者相比，接受监测的患者肿瘤较小，更常接受根治性治疗，生存更好。
在欧洲环境中，只有 22%的 HCC 通过监测诊断，超过三分之一的情况下，尽管应进行监测但却被忽视。NAFLD 和酒精性肝病与监测不足有关。尽管监测表明但漏诊，但与漏诊的患者相比，接受监测的患者生存明显更好。
