Zhao Changqing, Xing Feng, Yeo Yee Hui, Jin Michelle, Le Richard, Le Michael, Jin Mingjuan, Henry Linda, Cheung Ramsey, Nguyen Mindie H
Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, China.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto.
Eur J Gastroenterol Hepatol. 2020 Mar;32(3):406-419. doi: 10.1097/MEG.0000000000001523.
BACKGROUND/OBJECTS: Early hepatocellular carcinoma diagnosis is associated with better long-term survival. Studies of at-risk patients who are monitored in routine practice have reported an overall adherence rate to hepatocellular carcinoma screening/surveillance of approximately 60% and suboptimal diagnostic efficacy of the current screening/surveillance tools. However, it is unclear how many hepatocellular carcinoma patients were actually diagnosed via screening/surveillance given these obstacles. Therefore, via a systematic review of PubMed and Scopus databases from 2000 to 2019, we aimed to identify the proportion of patients with hepatocellular carcinoma diagnosed via screening/surveillance in routine practice.
We included original research articles of studies of patients already diagnosed with hepatocellular carcinoma that reported the proportion of hepatocellular carcinoma diagnosed via screening/surveillance.
The study included 60 studies and 50 554 hepatocellular carcinoma cases. The pooled proportion of hepatocellular carcinoma diagnosed by screening/surveillance was 37% (95% confidence interval: 31%-44%) and differed by geographic region (North America/Asia/Europe/Oceania/Africa/South America, 31%/42%/41%/30%/29%/47%, P = 0.017, respectively) and by surveillance interval (<12 months 39% vs. 12 months 19%, P < 0.01) but not by disease etiology, cirrhosis status, clinical setting, practice setting, hepatocellular carcinoma diagnosis period, or surveillance method.
Globally, hepatocellular carcinoma was diagnosed via screening/surveillance in less than half of the patients (37%) regardless of healthcare setting or liver disease etiology and without improvement over time despite several recent guideline updates. Research is needed to understand the barriers to screening/surveillance to include medical as well as social and cultural influences.
背景/目的：早期肝细胞癌诊断与更好的长期生存率相关。对在常规实践中接受监测的高危患者的研究报告称，肝细胞癌筛查/监测的总体依从率约为60%，且当前筛查/监测工具的诊断效果欠佳。然而，鉴于这些障碍，尚不清楚实际通过筛查/监测确诊的肝细胞癌患者有多少。因此，通过对2000年至2019年PubMed和Scopus数据库进行系统综述，我们旨在确定在常规实践中通过筛查/监测确诊的肝细胞癌患者比例。
我们纳入了已确诊为肝细胞癌患者的研究的原始研究文章，这些文章报告了通过筛查/监测确诊的肝细胞癌比例。
该研究纳入了60项研究和50554例肝细胞癌病例。通过筛查/监测确诊的肝细胞癌汇总比例为37%（95%置信区间：31%-44%），并因地理区域（北美/亚洲/欧洲/大洋洲/非洲/南美洲，分别为31%/42%/41%/30%/29%/47%，P = 0.017）和监测间隔（<12个月为39%，而12个月为19%，P < 0.01）而有所不同，但不受疾病病因、肝硬化状态、临床环境、实践环境、肝细胞癌诊断时期或监测方法的影响。
在全球范围内，无论医疗环境或肝病病因如何，不到一半的患者（37%）通过筛查/监测确诊，尽管最近有多项指南更新，但随着时间的推移并无改善。需要开展研究以了解筛查/监测的障碍，包括医学以及社会和文化影响。
