Chinnaratha Mohamed A, Campbell Kirsty, Mathias Ryan, McCormick Rosemary J, Woodman Richard J, Wigg Alan J
Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Bedford Park, SA, Australia.
School of Medicine, Flinders University, Bedford Park, Australia.
J Gastrointest Cancer. 2019 Dec;50(4):888-893. doi: 10.1007/s12029-018-0171-7.
To assess the overall survival (OS) in those with hepatocellular carcinoma (HCC) diagnosed within a programmatic, centrally co-ordinated, regional screening programme.
A retrospective cohort analysis of consecutive HCC patients diagnosed between 2004 and 2013. Patients were followed up till death or end of study period (30 April 2015). A dedicated screening programme was commenced in 2009 to screen high-risk patients for HCC. Primary objective is to compare the OS between HCC patients diagnosed within the screening group versus those diagnosed outside this group. Other objectives were to compare tumour stage at diagnosis and the proportion having curative treatments in the two groups. Propensity score adjustments were performed to assess the survival benefit.
HCC was diagnosed in 130 subjects during the study period (82.3% males, median [IQR] age 62 [± 19] years and median [IQR] follow-up of 11.3 (± 23.5) months). Ninety-six patients (73.8%) died during the follow-up, and the median (95%CI) OS was 15.7 (9.7-21.8) months. HCC diagnosed within the screening programme had a better OS compared to those diagnosed outside this programme (26.8 vs 11.5 months, p = 0.01). Further, those diagnosed within the programme had an earlier stage HCC ([58.3% vs 23.6%], Ӽ = 11.3, p = 0.001), and a significant proportion were treated with curative intent ([62.5% vs 31.1%], Ӽ = 8.3, p = 0.004). Propensity score adjustment showed a 58% reduction in mortality for HCC diagnosed within the screening programme (HR [95%CI] 0.42 [0.20-0.89], p = 0.02).
A programmatic, regional HCC screening programme improved the OS and detected tumours at an earlier stage enabling more patients to have curative therapies.
评估在一项系统性、集中协调的区域筛查计划中被诊断为肝细胞癌（HCC）患者的总生存期（OS）。
对2004年至2013年间连续诊断的HCC患者进行回顾性队列分析。患者随访至死亡或研究期结束（2015年4月30日）。2009年启动了一项专门的筛查计划，以筛查HCC高危患者。主要目的是比较筛查组内诊断出的HCC患者与组外诊断出的患者的总生存期。其他目的是比较两组诊断时的肿瘤分期以及接受根治性治疗的比例。进行倾向评分调整以评估生存获益。
研究期间130名受试者被诊断为HCC（82.3%为男性，年龄中位数[四分位间距]为62[±19]岁，随访时间中位数[四分位间距]为11.3（±23.5）个月）。96名患者（73.8%）在随访期间死亡，总生存期的中位数（95%CI）为15.7（9.7 - 21.8）个月。与筛查计划外诊断出的患者相比，筛查计划内诊断出的HCC患者总生存期更长（26.8个月对11.5个月，p = 0.01）。此外，计划内诊断出的患者HCC分期更早（[58.3%对23.6%]，χ² = 11.3，p = 0.001），并且很大一部分接受了根治性治疗（[62.5%对31.1%]，χ² = 8.3，p = 0.004）。倾向评分调整显示，筛查计划内诊断出的HCC患者死亡率降低了58%（风险比[95%CI]0.42[0.20 - 0.89]，p = 0.
