肝细胞癌监测的定制算法：一刀切的策略过时了吗？
Tailored algorithms for hepatocellular carcinoma surveillance: Is one-size-fits-all strategy outdated?
作者信息
Goossens Nicolas, Bian C Billie, Hoshida Yujin
机构信息
Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, USA; Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland.
Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
出版信息
Curr Hepatol Rep. 2017 Mar;16(1):64-71. doi: 10.1007/s11901-017-0336-z. Epub 2017 Feb 1.
PURPOSE OF REVIEW
Current clinical practice guidelines recommend regular hepatocellular carcinoma (HCC) surveillance with biannual ultrasound with or without serum alpha-fetoprotein uniformly applied to all patients with cirrhosis. However, clinical implementation of this one-size-fits-all strategy has been challenging as evidenced by very low application rate below 20% due to various reasons, including suboptimal performance of the surveillance modalities.
RECENT FINDINGS
Newly emerging imaging techniques such as abbreviated MRI (AMRI) and molecular HCC risk biomarkers have increasingly become available for clinical evaluation and implementation. These technologies may have a potential to reshape HCC surveillance by enabling tailored strategies. This would involve performing optimized surveillance tests according to individual HCC risk, and allocating limited medical resources for HCC surveillance based on cost-effectiveness.
SUMMARY
Tailored HCC surveillance could lead to achievement of precision HCC care and substantial improvement of the current dismal patient prognosis.
综述目的
当前临床实践指南建议，对所有肝硬化患者统一进行定期肝细胞癌（HCC）监测，每半年进行一次超声检查，可联合或不联合血清甲胎蛋白检测。然而，这种一刀切的策略在临床实施过程中面临挑战，由于各种原因，包括监测方式的性能欠佳，其应用率极低，低于20%。
最新发现
诸如简化磁共振成像（AMRI）和分子HCC风险生物标志物等新兴成像技术越来越多地可用于临床评估和实施。这些技术可能通过实现个性化策略来重塑HCC监测。这将涉及根据个体HCC风险进行优化的监测测试，并基于成本效益为HCC监测分配有限的医疗资源。
总结
个性化HCC监测可实现精准的HCC治疗，并显著改善目前患者不佳的预后。
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