Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA.
J Clin Gastroenterol. 2019 Jan;53(1):65-70. doi: 10.1097/MCG.0000000000001024.
To evaluate rates and predictors of retention into hepatocellular carcinoma (HCC) surveillance beyond initial screening among underserved cirrhosis patients.
Although initial HCC screening among cirrhosis patients remains low, few studies have evaluated retention to HCC surveillance beyond initial screening.
We retrospectively evaluated all consecutive adults with cirrhosis from 2014 to 2017 at a single underserved safety net hospital system to determine rates of HCC surveillance at 6 months and at 1 year beyond initial screening. Rates of HCC surveillance was stratified by sex, race/ethnicity, and etiology of liver disease. Multivariate Cox proportional hazards models evaluated predictors of retention into HCC surveillance.
Among 235 cirrhosis patients [hepatitis C virus: 35.7%, hepatitis B virus (HBV): 15.7%, alcoholic cirrhosis: 36.2%, nonalcoholic steatohepatitis (NASH): 8.1%], mean age of cirrhosis diagnosis was 54.2±8.9 years. Overall, 74.8% received initial screening within 1 year of cirrhosis diagnosis. Among those who completed initial screening, 47.6% [95% confidence interval (CI), 41.4-54.2) received second surveillance within 1 year. On multivariate analyses, patients with NASH and HBV were significantly more likely to receive second HCC surveillance compared with hepatitis C virus, HBV (hazard ratio, 2.32; 95% CI, 1.18-4.56; P=0.014) and NASH (hazard ratio, 2.49; 95% CI, 1.22-5.11; P=0.012). No sex or race-specific/ethnicity-specific differences in HCC surveillance retention were observed.
Although overall rates of initial HCC screening among cirrhosis patients is nearly 75%, retention into continued HCC surveillance is poor, with less than half of patients undergoing subsequent HCC surveillance. Cirrhosis patients with HBV and NASH were more likely to be retained into HCC surveillance.
评估在服务不足的肝硬化患者中，初始筛查后继续进行肝细胞癌 (HCC) 监测的比例和预测因素。
尽管肝硬化患者的初始 HCC 筛查仍然较低，但很少有研究评估初始筛查后继续 HCC 监测的保留率。
我们回顾性评估了 2014 年至 2017 年期间在一家单一的服务不足的安全网医院系统中的所有连续肝硬化成年患者，以确定初始筛查后 6 个月和 1 年时 HCC 监测的比例。根据性别、种族和肝脏疾病的病因对 HCC 监测的比例进行分层。多变量 Cox 比例风险模型评估了保留 HCC 监测的预测因素。
在 235 名肝硬化患者中[丙型肝炎病毒：35.7%，乙型肝炎病毒 (HBV)：15.7%，酒精性肝硬化：36.2%，非酒精性脂肪性肝炎 (NASH)：8.1%]，肝硬化诊断的平均年龄为 54.2±8.9 岁。总体而言，74.8%的患者在肝硬化诊断后 1 年内接受了初始筛查。在完成初始筛查的患者中，47.6%[95%置信区间 (CI)，41.4-54.2]在 1 年内接受了第二次监测。在多变量分析中，与丙型肝炎病毒相比，NASH 和 HBV 患者更有可能接受第二次 HCC 监测，HBV (风险比，2.32；95%CI，1.18-4.56；P=0.014) 和 NASH (风险比，2.49；95%CI，1.22-5.11；P=0.012)。在 HCC 监测保留方面，未观察到性别或种族/民族特异性差异。
尽管肝硬化患者的初始 HCC 筛查总体率接近 75%，但继续进行 HCC 监测的保留率很差，只有不到一半的患者接受了后续 HCC 监测。患有 HBV 和 NASH 的肝硬化患者更有可能被保留在 HCC 监测中。
