Sherman Morris
University Health Network, Toronto.
JHEP Rep. 2019 Nov 5;1(6):460-467. doi: 10.1016/j.jhepr.2019.10.007. eCollection 2019 Dec.
Outside of expert centres, surveillance programmes for hepatocellular carcinoma (HCC) are not well executed. There are deficiencies in every stage of the process. Overcoming these obstacles is the most important method for improving surveillance. However, even if these obstacles were overcome, there would still be room for improvement. Assessing who is at risk of developing HCC remains incompletely validated. At present, risk scores have been developed for different causes of liver disease, but scores developed in different parts of the world for the same disease do not always agree. Furthermore, most scores stratify patients by risk but do not examine what level of risk should trigger surveillance. Which surveillance tools to use remains controversial - schemes have been proposed that use biomarkers alone, ultrasound alone, or a combination of both. However, the requisite level of test sensitivity that would be associated with high cure rates has not been defined, so at this point it is not clear whether surveillance requires both ultrasound and biomarkers, or whether the use of biomarkers alone is sufficient. Finally, surveillance should result in the identification of HCC at a very early stage. Diagnosing these lesions is difficult and optimal algorithms for lesions that are atypical on radiology have yet to be developed. Algorithms for the follow-up of abnormal biomarkers in the absence of ultrasound have also not been developed yet.
在专业中心之外，肝细胞癌（HCC）的监测项目执行情况不佳。该过程的每个阶段都存在缺陷。克服这些障碍是改善监测的最重要方法。然而，即使克服了这些障碍，仍有改进的空间。评估谁有患HCC的风险仍未得到充分验证。目前，已经针对不同的肝病病因制定了风险评分，但世界不同地区针对同一种疾病制定的评分并不总是一致。此外，大多数评分按风险对患者进行分层，但并未研究何种风险水平应触发监测。使用哪些监测工具仍存在争议——有人提出了仅使用生物标志物、仅使用超声或两者结合的方案。然而，与高治愈率相关的必要检测灵敏度水平尚未确定，因此目前尚不清楚监测是否需要超声和生物标志物两者，还是仅使用生物标志物就足够了。最后，监测应能在非常早期发现HCC。诊断这些病变很困难，针对放射学上不典型病变的最佳算法尚未开发出来。在没有超声的情况下对异常生物标志物进行随访的算法也尚未开发出来。
