Department of General Internal Medicine, Inselspital-Bern University Hospital, Freiburgstrasse 4, 3010, Bern, Switzerland.
Hepatology, Department of Visceral Surgery and Medicine, Inselspital-Bern University Hospital, Freiburgstrasse 4, 3010, Bern, Switzerland.
Dig Dis Sci. 2019 Apr;64(4):903-909. doi: 10.1007/s10620-019-05515-8.
The prognosis of patients with hepatocellular carcinoma is dependent on the stage of tumor at diagnosis. The earlier the tumor is found, the higher the chances to offer a curative treatment. In order to diagnose hepatocellular carcinoma early, patients at risk should be enrolled in a surveillance program. The population at risk is usually defined as patients with cirrhosis. These patients should have twice a year a ultrasonographic examination of the liver. However, more and more patients will develop hepatocellular carcinoma in the context of nonalcoholic fatty liver disease which is tightly linked to obesity and diabetes. In these patients, this approach is jeopardized by the difficulty to perform a sonography of good quality due to the obesity and more importantly by the fact that hepatocellular carcinoma occurs frequently in the context of nonalcoholic fatty liver disease before the cirrhosis. This article reviews the impact of the changing epidemiology of hepatocellular carcinoma on its screening.
肝细胞癌患者的预后取决于诊断时肿瘤的分期。肿瘤越早发现，提供治愈性治疗的机会就越高。为了早期诊断肝细胞癌，应将有风险的患者纳入监测计划。高危人群通常定义为肝硬化患者。这些患者应每年两次进行肝脏超声检查。然而，越来越多的患者将在与肥胖和糖尿病密切相关的非酒精性脂肪性肝病的背景下发展为肝细胞癌。在这些患者中，由于肥胖导致超声质量难以提高，更重要的是由于在肝硬化之前，非酒精性脂肪性肝病背景下肝细胞癌经常发生，这种方法受到了威胁。本文综述了肝细胞癌流行病学变化对其筛查的影响。
