Appel-da-Silva Marcelo Campos, Miozzo Suelen Aparecida da Silva, Dossin Isabella de Azevedo, Tovo Cristiane Valle, Branco Fernanda, de Mattos Angelo Alves
Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
World J Gastroenterol. 2016 Dec 14;22(46):10219-10225. doi: 10.3748/wjg.v22.i46.10219.
To determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients.
In this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis.
Four hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1 year, 15.4% in the 5 year, and 28.8% in the 10 year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients ( < 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less ( = 0.05). However, survival was not different between patients with early stage non-early stage tumors [HR = 0.54 (0.15-1.89), = 0.33].
HCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.
确定肝细胞癌（HCC）的发病率以及HCC监测对肝硬化门诊患者早期诊断和生存的影响。
在这项回顾性队列研究中，分析了2005年3月至2014年3月期间接受HCC监测的肝硬化门诊患者。排除标准为合并HIV感染；既往器官移植；初诊时诊断为HCC；病历中数据缺失；以及随访时间少于1年。每六个月使用超声和血清甲胎蛋白测定进行监测。通过Kaplan-Meier分析估计十年累积发病率和生存率。
共纳入453例患者，其中57.6%为男性。平均年龄为55岁。丙型肝炎病毒和大量饮酒是肝硬化的主要病因。75例患者（16.6%）诊断为HCC，估计1年累积发病率为2.6%，5年为15.4%，10年为28.8%。HCC患者的中位生存期估计为17.6个月，而非HCC患者为234个月（<0.001）。在每6个月或更短时间接受一次监测的患者中，更常检测到早期HCC（P = 0.05）。然而，早期和非早期肿瘤患者的生存率没有差异[风险比（HR）= 0.54（0.15 - 1.89），P = 0.33]。
HCC是肝硬化患者常见的并发症，坚持监测计划有利于早期诊断。
