Prapruttam Duangkamon, Suksai Jitkasem, Kitiyakara Taya, Phongkitkarun Sith
J Med Assoc Thai. 2014 Nov;97(11):1199-208.
Surveillance for hepatocellular carcinoma (HCC) is recommended for patients at risk of developing HCC. However the pattern of surveillance in clinical practice is unclear.
To assess the adherence of surveillance program in the detection of HCC and to determine the prevalence of HCC in the at-risk patients who were on surveillance in Ramathibodi Hospital.
Retrospective descriptive study of at-risk patients, who were followed in the liver clinic at Ramathibodi Hospital between January 1, 2007 and December 31, 2012. Clinical data were collected from electronic medical records and radiologic data were extractedfrom the radiology database (PACS). The US findings of focal liver lesion were analyzed for number size, location, and echogenicity. When focal liver lesions suggestive of HCC were detected on ultrasonography, dynamic contrast enhanced CT or AMRI was used to diagnose HCC. On CT/MRI, focal lesions were considered to be HCC when hypervascularity in the arterial phase and washout in the portal venous or delayed phase was found
Nine hundred seven patients with risk(s) for HCC underwent ultrasound surveillance. The mean number of ultrasound examinations per patient was 4.7±2.2 scans during the course offollow-up. The mean total adherence time was 37.0±17.1 months. The median time interval between each ultrasound examination was 8.4 months (range: 1.1-63.0 months). Focal liver lesions were detected in 161 of 907patients (17.8%). No new focal liver lesion was detected at less than 3-month interval. The majority of patients were evaluatedfurther by MRI (n = 99; 62.3%) or by CT scan (n = 33; 20.8%). Theperiod prevalence of HCC in patients who received US surveillance was 3.5% (32 patients in 907patients). Most ofpatients with HCC were male (71.9%) and the major risk factor was chronic hepatitis B (50.0%). Twenty-one of 32 patients (65.6%) had normal serum AFP levels. Most HCC's (75.0%) were detected at 8-month interval. The cumulative percentage of HCC's detected at 6-month and 12-month surveillance intervals were 11.1% and 70.4%, respectively. The median tumor size was 22.5 mm, ranging from 12-134 mm. At the time ofHCC diagnosis, eight patients (25.0%) had HCC within BCLC very early stage (by size criteria) and 19 patients (59.4%) were in BCLC early stage.
Although there were irregular surveillance intervals in our clinical practice, the overall adherence ofpatients to surveillance was acceptable, with the period prevalence of HCC 3.5% and the majority discovered in the early stage.
对于有发生肝细胞癌（HCC）风险的患者，建议进行HCC监测。然而，临床实践中的监测模式尚不清楚。
评估监测计划在HCC检测中的依从性，并确定在拉玛提博迪医院接受监测的高危患者中HCC的患病率。
对2007年1月1日至2012年12月31日在拉玛提博迪医院肝脏门诊随访的高危患者进行回顾性描述性研究。临床数据从电子病历中收集，放射学数据从放射学数据库（PACS）中提取。分析肝脏局灶性病变的超声检查结果，包括数量、大小、位置和回声性。当超声检查发现提示HCC的肝脏局灶性病变时，采用动态对比增强CT或MRI进行HCC诊断。在CT/MRI上，当在动脉期发现高血管性且在门静脉期或延迟期出现洗脱时，局灶性病变被认为是HCC。
907例有HCC风险的患者接受了超声监测。在随访期间，每位患者超声检查的平均次数为4.7±2.2次。平均总依从时间为37.0±17.1个月。每次超声检查之间的中位时间间隔为8.4个月（范围：1.1 - 63.0个月）。907例患者中有161例（17.8%）检测到肝脏局灶性病变。在间隔少于3个月时未发现新的肝脏局灶性病变。大多数患者进一步接受了MRI检查（n = 99；62.3%）或CT扫描（n = 33；20.8%）。接受超声监测的患者中HCC的期间患病率为3.5%（907例患者中有32例）。大多数HCC患者为男性（71.9%），主要危险因素是慢性乙型肝炎（50.0%）。32例患者中有21例（65.6%）血清甲胎蛋白（AFP）水平正常。大多数HCC（75.0%）在8个月的间隔时被检测到。在6个月和12个月监测间隔时检测到的HCC累积百分比分别为11.1%和70.4%。肿瘤中位大小为直径22.5mm，范围为12 - 134mm。在HCC诊断时，8例患者（25.0%）处于巴塞罗那临床肝癌（BCLC）极早期（按大小标准），19例患者（59.4%）处于BCLC早期。
尽管我们的临床实践中监测间隔不规律，但患者对监测的总体依从性是可以接受的，HCC的期间患病率为3.5%，且大多数在早期被发现。
