Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal and CRCHUM, 1058 rue Saint-Denis, Montréal, QC, H2X 3J4, Canada.
Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
Abdom Radiol (NY). 2018 Jan;43(1):13-25. doi: 10.1007/s00261-017-1209-1.
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer mortality worldwide. Incidence rates of liver cancer vary widely between geographic regions and are highest in Eastern Asia and sub-Saharan Africa. In the United States, the incidence of HCC has increased since the 1980s. HCC detection at an early stage through surveillance and curative therapy has considerably improved the 5-year survival. Therefore, medical societies advocate systematic screening and surveillance of target populations at particularly high risk for developing HCC to facilitate early-stage detection. Risk factors for HCC include cirrhosis, chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV), excess alcohol consumption, non-alcoholic fatty liver disease, family history of HCC, obesity, type 2 diabetes mellitus, and smoking. Medical societies utilize risk estimates to define target patient populations in which imaging surveillance is recommended (risk above threshold) or in which the benefits of surveillance are uncertain (risk unknown or below threshold). All medical societies currently recommend screening and surveillance in patients with cirrhosis and subsets of patients with chronic HBV; some societies also include patients with stage 3 fibrosis due to HCV as well as additional groups. Thus, target population definitions vary between regions, reflecting cultural, demographic, economic, healthcare priority, and biological differences. The Liver Imaging Reporting and Data System (LI-RADS) defines different patient populations for surveillance and for diagnosis and staging. We also discuss general trends pertaining to geographic region, age, gender, ethnicity, impact of surveillance on survival, mortality, and future trends.
肝细胞癌 (HCC) 是全球第六大常见癌症和第二大癌症死亡原因。肝癌的发病率在不同地理区域之间差异很大，在东亚和撒哈拉以南非洲地区发病率最高。在美国，自 20 世纪 80 年代以来，HCC 的发病率一直在增加。通过监测和治愈性治疗早期发现 HCC，大大提高了 5 年生存率。因此，医学协会提倡对具有发生 HCC 高风险的特定人群进行系统筛查和监测，以促进早期发现。HCC 的危险因素包括肝硬化、慢性乙型肝炎病毒 (HBV) 感染、丙型肝炎病毒 (HCV) 感染、过量饮酒、非酒精性脂肪性肝病、HCC 家族史、肥胖、2 型糖尿病和吸烟。医学协会利用风险估计来定义推荐进行影像学监测的目标患者人群（风险高于阈值）或监测的益处不确定的患者人群（风险未知或低于阈值）。目前所有医学协会都建议对肝硬化患者和慢性 HBV 的部分患者进行筛查和监测；一些协会还将 HCV 导致的 3 期纤维化患者以及其他一些群体纳入监测范围。因此，目标人群的定义因地区而异，反映了文化、人口统计学、经济、医疗保健重点和生物学差异。肝脏成像报告和数据系统 (LI-RADS) 为监测和诊断及分期定义了不同的患者人群。我们还讨论了与地理区域、年龄、性别、种族、监测对生存率、死亡率和未来趋势的影响有关的一般趋势。
