Mittal Sahil, Kanwal Fasiha, Ying Jun, Chung Randy, Sada Yvonne H, Temple Sarah, Davila Jessica A, El-Serag Hashem B
Section of Gastroenterology and Hepatology, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Section of Gastroenterology and Hepatology, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
J Hepatol. 2016 Dec;65(6):1148-1154. doi: 10.1016/j.jhep.2016.07.025. Epub 2016 Jul 29.
BACKGROUND & AIMS: The effectiveness of surveillance for hepatocellular carcinoma (HCC) in reducing cancer related mortality among patients with cirrhosis is largely unknown. The objective of this study was to study the effectiveness of HCC surveillance in the national Veterans Administration (VA) clinical practice.
We conducted a retrospective cohort study of patients with HCC during 2005-2010 by reviewing patients' medical records to determine receipt of HCC surveillance in the 2years prior to HCC diagnosis. We determined association of HCC surveillance with overall mortality adjusting for age, risk factors, model for end-stage liver disease (MELD) score, comorbidity index, alpha-fetoprotein levels, healthcare utilization, Barcelona Clinic Liver Cancer (BCLC) stage, and treatment. We accounted for lead and length time biases.
Of 887 patients with HCC, only 412 (46.5%) received any surveillance prior to HCC diagnosis. Patients who received surveillance were significantly more likely to have early stage disease HCC (BCLC stage 0/A 27.2% vs. 11.6%) and receive potentially curative (20.9% vs. 11.6%) or palliative (59.2% vs. 45.5%) treatments compared to those without HCC surveillance. Receipt of HCC surveillance was associated with 38% reduction in mortality risk (unadjusted hazard ratios (HR) 0.62, 95% confidence intervals (CI) 0.54-0.71) that declined to 20% (HR 0.80, 95% CI 0.69-0.94) after adjusting for HCC stage and treatment, compared to those without HCC surveillance.
Among patients with HCC, pre-diagnosis HCC surveillance is associated with a significant 38% reduction in overall mortality. The reduction in mortality risk with surveillance is mediated via stage migration and receipt of HCC specific treatment.
Surveillance for liver cancer leads to earlier detection of cancer and increases chances of getting curative treatment. This ultimately leads to increased longevity in patients with liver cancer.
肝细胞癌（HCC）监测在降低肝硬化患者癌症相关死亡率方面的有效性很大程度上未知。本研究的目的是在国家退伍军人事务部（VA）临床实践中研究HCC监测的有效性。
我们通过回顾患者的病历，对2005年至2010年期间的HCC患者进行了一项回顾性队列研究，以确定在HCC诊断前2年是否接受了HCC监测。我们确定了HCC监测与总体死亡率之间的关联，并对年龄、危险因素、终末期肝病模型（MELD）评分、合并症指数、甲胎蛋白水平、医疗保健利用情况、巴塞罗那临床肝癌（BCLC）分期和治疗进行了调整。我们考虑了领先时间和病程时间偏倚。
在887例HCC患者中，只有412例（46.5%）在HCC诊断前接受了任何监测。与未接受HCC监测的患者相比，接受监测的患者更有可能患有早期HCC疾病（BCLC 0/A期，27.2%对11.6%），并接受潜在的治愈性治疗（20.9%对11.6%）或姑息性治疗（59.2%对45.5%）。与未接受HCC监测的患者相比，接受HCC监测与死亡风险降低38%相关（未调整的风险比（HR）为0.62，95%置信区间（CI）为0.54-0.71），在调整HCC分期和治疗后，这一比例降至20%（HR为0.80，95%CI为0.69-0.94）。
在HCC患者中，诊断前的HCC监测与总体死亡率显著降低38%相关。监测导致的死亡风险降低是通过分期迁移和接受HCC特异性治疗介导的。
肝癌监测可导致癌症的早期发现，并增加获得治愈性治疗的机会。这最终会延长肝癌患者的寿命。
