Frenette Catherine T, Isaacson Ari J, Bargellini Irene, Saab Sammy, Singal Amit G
Scripps Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA.
Department of Radiology, University of North Carolina, Chapel Hill.
Mayo Clin Proc Innov Qual Outcomes. 2019 Jul 11;3(3):302-310. doi: 10.1016/j.mayocpiqo.2019.04.005. eCollection 2019 Sep.
Hepatocellular carcinoma (HCC) arises in the context of cirrhosis and chronic hepatitis B virus (HBV) infections, and the diagnosis is often made at advanced stages. Because early-stage diagnosis improves survival, guidelines recommend screening patients at risk for HCC, such as patients with cirrhosis. However, adherence to screening programs is suboptimal. In this review, we discuss the value of HCC screening and provide practical guidance on patient selection and screening methods. International guidelines concordantly recommend HCC screening in patients with cirrhosis, including patients with HBV infections, hepatitis C virus infections with or without sustained virologic response, and nonalcoholic fatty liver disease. There is no consensus on screening patients without cirrhosis, although patients with advanced fibrosis, HBV infections, or nonalcoholic fatty liver disease without cirrhosis have an increased risk for development of HCC. Screening for HCC improves early tumor detection, receipt of curative treatment, and overall survival in at-risk patients. However, potential harms of HCC screening have not been well quantified. Semiannual abdominal ultrasonography is the screening modality of choice. Using ultrasonography in combination with biomarkers, such as α-fetoprotein, may increase accuracy for early HCC detection. The use of magnetic resonance imaging and computed tomography is limited by cost-effectiveness and practical considerations. Increased awareness of HCC screening will allow for earlier diagnosis and potentially curative treatment. We propose a comprehensive screening algorithm for patients at risk for development of HCC, recommending lifelong, semiannual ultrasonography combined with α-fetoprotein testing in patients with cirrhosis and selected patients without cirrhosis.
肝细胞癌（HCC）发生于肝硬化和慢性乙型肝炎病毒（HBV）感染的背景下，诊断往往在疾病晚期作出。由于早期诊断可提高生存率，指南建议对HCC高危患者进行筛查，如肝硬化患者。然而，筛查计划的依从性并不理想。在本综述中，我们讨论了HCC筛查的价值，并就患者选择和筛查方法提供实用指导。国际指南一致建议对肝硬化患者进行HCC筛查，包括HBV感染患者、丙型肝炎病毒感染且有或无持续病毒学应答的患者以及非酒精性脂肪性肝病患者。对于无肝硬化患者的筛查尚无共识，尽管晚期纤维化患者、HBV感染患者或无肝硬化的非酒精性脂肪性肝病患者发生HCC的风险增加。HCC筛查可提高高危患者的早期肿瘤检测率、接受根治性治疗的比例以及总体生存率。然而，HCC筛查的潜在危害尚未得到充分量化。半年一次的腹部超声检查是首选的筛查方式。将超声检查与生物标志物（如甲胎蛋白）联合使用可能会提高早期HCC检测的准确性。磁共振成像和计算机断层扫描的使用受到成本效益和实际考虑因素的限制。提高对HCC筛查的认识将有助于早期诊断并可能进行根治性治疗。我们为有发生HCC风险的患者提出了一种全面的筛查算法，建议对肝硬化患者和部分无肝硬化患者进行终身半年一次的超声检查并联合甲胎蛋白检测。
