Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
J Gastroenterol Hepatol. 2020 Oct;35(10):1795-1803. doi: 10.1111/jgh.15046. Epub 2020 Apr 20.
Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-monthly ultrasonography (US). However, sensitivities of US to detect early-stage HCC in cirrhotic patients are suboptimal. We aimed to compare overall survival and detection rates of very-early-stage HCC in two groups: group A, undergoing 6-monthly US versus group B, undergoing 6-monthly US alternating with dynamic computed tomography (CT).
This retrospective multicenter study assessed 1235 cirrhotic patients with CHB under entecavir/tenofovir therapy from 2007 to 2016. The primary endpoint was overall survival rates between the two groups. The Cox proportional hazards model and propensity score matching analyses were used to assess the effect of surveillance modalities on overall survival and detection of Barcelona Clinic Liver Cancer stage 0 HCC after balancing.
During a median follow-up of 4.5 years, 10-year cumulative HCC incidence rates of 16.3% were significantly higher in group B (n = 576) than 13.7% in group A (n = 659; P < 0.001). However, in patients with HCC, 10-year overall survival rates of 85.1% were significantly higher in group B than 65.6% in group A (P = 0.001 by log-rank test). CT exam alternating with US was independently associated with reduced overall mortality (hazard ratio 0.47, P = 0.02). Cumulative incidence of Barcelona Clinic Liver Cancer stage 0 HCC was significantly higher in group B than in group A (hazard ratio 2.82, P < 0.001).
In cirrhotic patients with CHB, dynamic CT exam alternating with US led to higher detection rates of very-early-stage HCC and benefit of overall survival than did US exams.
目前慢性乙型肝炎（CHB）患者的指南是每 6 个月进行超声检查（US）以监测肝细胞癌（HCC）。然而，US 检测肝硬化患者早期 HCC 的敏感性并不理想。我们旨在比较两组患者的总生存率和非常早期 HCC 的检出率：A 组每 6 个月行 US 检查，B 组每 6 个月行 US 检查与动态计算机断层扫描（CT）交替进行。
本回顾性多中心研究评估了 2007 年至 2016 年期间接受恩替卡韦/替诺福韦治疗的 1235 例乙型肝炎肝硬化患者。主要终点是两组之间的总生存率。使用 Cox 比例风险模型和倾向评分匹配分析来评估监测方式对总体生存和平衡后巴塞罗那临床肝癌 0 期 HCC 检出率的影响。
在中位随访 4.5 年期间，B 组（n=576）10 年累积 HCC 发生率为 16.3%，显著高于 A 组（n=659）的 13.7%（P<0.001）。然而，在 HCC 患者中，B 组的 10 年总生存率为 85.1%，显著高于 A 组的 65.6%（log-rank 检验 P=0.001）。CT 检查与 US 交替检查与降低总死亡率独立相关（风险比 0.47，P=0.02）。B 组的巴塞罗那临床肝癌 0 期 HCC 的累积发生率明显高于 A 组（风险比 2.82，P<0.001）。
在乙型肝炎肝硬化患者中，与 US 检查相比，动态 CT 检查与 US 交替检查可提高非常早期 HCC 的检出率，并提高总生存率。
