Liver Unit, Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
J Gastroenterol Hepatol. 2018 Aug;33(8):1524-1529. doi: 10.1111/jgh.14108. Epub 2018 Mar 22.
Surveillance for hepatocellular carcinoma (HCC) intends to detect tumors at an early stage to improve survival. The study aims were to assess the frequency and risk factors associated with HCC surveillance failure.
The study analyzed data from 188 consecutive patients diagnosed with HCC within a surveillance program conducted among 1,242 cirrhotic patients and based on ultrasonography and alpha-fetoprotein (AFP) testing every 3 or 6 months. Program failure was defined as the detection of HCC exceeding the Milan criteria. Variables recorded at entry into the program, during follow-up and at HCC diagnosis, were analyzed.
At diagnosis, 50 (26.6%) HCC tumors were beyond the Milan criteria. In univariate analysis, Child-Pugh B at entry (P = 0.03), development of complications of portal hypertension before tumor diagnosis (P = 0.03), and failure to complete the prior screening round (P = 0.02), Child-Pugh B/C (P = 0.001) and AFP ≥ 100 ng/mL (P = 0.03) at diagnosis, were associated with failure. In multivariate analysis, only Child-Pugh B/C (hazard ratio, 3.18; 95% confidence interval, 1.66-6.10, P < 0.001) and AFP ≥ 100 ng/mL, both at diagnosis (hazard ratio, 2.80; 95% confidence interval, 1.37-5.71, P = 0.005), were independently associated with failure. Survival was higher among patients with tumors within the Milan criteria than those with program failure (33.9 vs 7.6 months, P < 0.001).
Approximately 25% of HCC cases diagnosed among patients included in a surveillance program were beyond the Milan criteria. Child-Pugh B/C and AFP ≥ 100 ng/mL at diagnosis were associated with program failure. However, Child-Pugh B at entry and development of liver-related complications during follow-up can be early predictors of failure.
肝细胞癌（HCC）监测旨在早期发现肿瘤，以提高生存率。本研究旨在评估 HCC 监测失败的频率和相关风险因素。
本研究分析了在一项针对 1242 例肝硬化患者的超声和甲胎蛋白（AFP）每 3 或 6 个月检测的监测计划中连续诊断的 188 例 HCC 患者的数据。监测失败定义为检测到超过米兰标准的 HCC。分析了进入该计划时、随访期间和 HCC 诊断时记录的变量。
在诊断时，50 例（26.6%）HCC 肿瘤超出米兰标准。单因素分析显示，入组时 Child-Pugh B（P=0.03）、肿瘤诊断前发生门静脉高压并发症（P=0.03）以及未能完成前一轮筛查（P=0.02）、Child-Pugh B/C（P=0.001）和 AFP≥100ng/ml（P=0.03）与失败相关。多因素分析显示，只有 Child-Pugh B/C（风险比，3.18；95%置信区间，1.66-6.10，P<0.001）和 AFP≥100ng/ml（风险比，2.80；95%置信区间，1.37-5.71，P=0.005）在诊断时均与失败独立相关。肿瘤符合米兰标准的患者的生存率高于监测失败的患者（33.9 与 7.6 个月，P<0.001）。
在监测计划中纳入的患者中，约 25%的 HCC 病例被诊断为超出米兰标准。诊断时的 Child-Pugh B/C 和 AFP≥100ng/ml 与监测失败相关。然而，入组时的 Child-Pugh B 和随访期间肝脏相关并发症的发生可能是失败的早期预测因素。
