Hallager S, Ladelund S, Kjaer M, Madsen L G, Belard E, Laursen A L, Gerstoft J, Røge B T, Grønbaek K E, Krarup H B, Christensen P B, Weis N
Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark.
J Viral Hepat. 2018 Jan;25(1):47-55. doi: 10.1111/jvh.12764. Epub 2017 Sep 22.
Cirrhosis in patients with chronic hepatitis C increases the risk of hepatocellular carcinoma (HCC), and surveillance with ultrasound (US) and alpha-fetoprotein (AFP) is recommended. This study aimed to estimate changes in the HCC incidence rate (IR) over time, HCC stage and prognosis, and AFP and US performed in patients with hepatitis C and cirrhosis. Eligible patients were identified in the Danish Database for Hepatitis B and C, and data from national health registries and patient charts were obtained. Tumour stage was based on Barcelona-Clinic Liver Cancer stage, TNM classification and size and number of lesions combined into stages 0-3. We included 1075 patients with hepatitis C and cirrhosis, free of HCC and liver transplant at baseline. During 4988 person years (PY), 115 HCC cases were diagnosed. The HCC incidence rate increased from 0.8/100 PY [CI95% 0.4-1.5] in 2002-2003 to 2.9/100 PY [2.4-3.4] in 2012-2013. One-year cumulative incidence of at least one AFP or US was 53% among all patients. The positive predictive value of an AFP ≥ 20 ng mL was 17%. Twenty-three (21%) patients were diagnosed with early-stage HCC (stage 0/1) and 84 (79%) with late stage. Median survival after HCC for early-stage HCC disease was 30.1 months and 7.4 months for advanced HCC (stage 2/3). The incidence rate of HCC increased over time among patients with hepatitis C and cirrhosis in Denmark. Application of AFP and US was suboptimal, and most patients were diagnosed with advanced HCC with a poor prognosis.
慢性丙型肝炎患者的肝硬化会增加肝细胞癌（HCC）的风险，因此建议采用超声（US）和甲胎蛋白（AFP）进行监测。本研究旨在评估HCC发病率（IR）随时间的变化、HCC分期及预后，以及丙型肝炎和肝硬化患者的AFP和US检测情况。在丹麦乙型和丙型肝炎数据库中确定符合条件的患者，并获取国家卫生登记处和患者病历的数据。肿瘤分期基于巴塞罗那临床肝癌分期、TNM分类以及病灶大小和数量，分为0 - 3期。我们纳入了1075例基线时无HCC且未接受肝移植的丙型肝炎和肝硬化患者。在4988人年（PY）期间，诊断出115例HCC病例。HCC发病率从2002 - 2003年的0.8/100 PY [CI95% 0.4 - 1.5]增加到2012 - 2013年的2.9/100 PY [2.4 - 3.4]。所有患者中至少进行一次AFP或US检测的一年累积发生率为53%。AFP≥20 ng/mL的阳性预测值为17%。23例（21%）患者被诊断为早期HCC（0/1期），84例（79%）为晚期。早期HCC疾病患者HCC后的中位生存期为30.1个月，晚期HCC（2/3期）为7.4个月。丹麦丙型肝炎和肝硬化患者中HCC的发病率随时间增加。AFP和US的应用并不理想，大多数患者被诊断为晚期HCC，预后较差。
