Department of Gastroenterology and Hepatology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Medicine, University of California San Diego, San Diego, La Jolla, CA, USA.
Scand J Gastroenterol. 2020 Feb;55(2):222-227. doi: 10.1080/00365521.2020.1718747. Epub 2020 Jan 28.
International guidelines recommend hepatocellular carcinoma (HCC) surveillance with ultrasound in high-risk patients with chronic liver diseases. However, there is low-strength evidence about the effects on mortality. The aim of our study was to assess the impact of surveillance on the clinical course and survival of HCC patients seen at a tertiary referral center in Germany. We retrospectively evaluated the data of 401 HCC patients, who presented to our clinic between 1997 and 2015. Two groups were compared regarding patient and disease outcomes: one group included patients who received at least two ultrasound examinations for surveillance purposes prior to first diagnosis ( = 111). The other group consisted of patients with HCC at first presentation without foregoing HCC surveillance ( = 290). Median follow-up in the surveillance group was 76 months (range 4-310 months). Patients in the surveillance group had smaller median tumor sizes (3.5 cm vs. 4.5 cm; < .001), fulfilled more often Milan criteria (64% vs. 42%; < .001) and received more often liver transplantation (27% vs. 9%, < .001) when compared with the non-surveillance group. However, HCC surveillance was not associated with an improved survival (14 months in the surveillance group vs. 12 months in the non-surveillance group, = .375), hazard ratio regarding overall mortality for the surveillance group: 0.80 (95% CI: 0.62-1.04, = .09). HCC surveillance with ultrasound led to the detection of earlier disease stages but was not significantly associated with improved survival. Further prospective and long-term studies are needed to clarify benefits and harms of HCC surveillance programs on mortality.
国际指南建议对患有慢性肝病的高危患者进行肝细胞癌（HCC）超声监测。然而，关于其对死亡率的影响的证据强度较低。我们的研究旨在评估监测对在德国一家三级转诊中心就诊的 HCC 患者的临床过程和生存的影响。我们回顾性评估了 1997 年至 2015 年间在我们诊所就诊的 401 例 HCC 患者的数据。比较了两组患者的结局：一组包括在首次诊断前至少进行了两次超声检查以进行监测的患者（n=111）；另一组包括首次就诊时即患有 HCC 而未进行 HCC 监测的患者（n=290）。监测组的中位随访时间为 76 个月（范围 4-310 个月）。监测组患者的肿瘤中位直径较小（3.5cm 比 4.5cm；<0.001），更常符合米兰标准（64%比 42%；<0.001），更常接受肝移植（27%比 9%；<0.001）。然而，与非监测组相比，HCC 监测并未改善生存（监测组 14 个月，非监测组 12 个月；=0.375），监测组全因死亡率的风险比为 0.80（95%CI：0.62-1.04，=0.09）。HCC 超声监测导致更早发现疾病阶段，但与改善生存无显著相关性。需要进一步进行前瞻性和长期研究，以阐明 HCC 监测方案对死亡率的获益和危害。
