Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon.
Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(12):1564-1572. doi: 10.1097/MEG.0000000000001870.
Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-month ultrasonography. We aimed to compare detection rates of very-early-stage HCC in two groups: group A, undergoing 6-month ultrasonography versus group B, undergoing 6-month ultrasonography alternating with dynamic computed tomography (CT).
This retrospective study assessed 2151 CHB patients under entecavir/tenofovir therapy from 2007 to 2016. Detection rates of very-early-stage HCC were compared between groups A/B at intermediate/high risk based on platelets, age, gender-hepatitis B scores. The primary endpoint was the proportion of patients in each group with very-early-stage HCC. Cox proportional hazards model was used to assess the effect of surveillance modalities to detect very-early-stage HCC.
Five-year cumulative HCC incidence rates in group A were 15.0% not significantly different from 18.2% in group B at high risk (P = 0.17). Detection rates of very-early-stage HCC were significantly higher in group B than in group A (P < 0.001), and surveillance using CT alternating with ultrasonography was significantly associated with detection of very-early-stage HCC (hazard ratio 3.89, P < 0.001). Among intermediate-risk patients, difference between detection rates of very-early-stage HCC in groups A and B was not significant (P = 0.30), and surveillance using CT alternating with ultrasonography was not significantly associated with detection of very-early-stage HCC (hazard ratio 1.61, P = 0.23).
In high-risk CHB patients, surveillance using CT alternating with ultrasonography led to higher detection rates of very-early-stage HCC compared to surveillance using ultrasonography.
目前，慢性乙型肝炎（CHB）患者的指南是每 6 个月进行超声检查以监测肝细胞癌（HCC）。我们旨在比较两组患者（A 组接受 6 个月超声检查，B 组接受 6 个月超声检查与动态计算机断层扫描（CT）交替）检测非常早期 HCC 的检出率。
本回顾性研究评估了 2007 年至 2016 年间接受恩替卡韦/替诺福韦治疗的 2151 例 CHB 患者。根据血小板、年龄、性别-乙型肝炎评分，将 A/B 两组中高危患者的非常早期 HCC 检出率进行比较。主要终点是每组中非常早期 HCC 患者的比例。使用 Cox 比例风险模型评估监测方式对检测非常早期 HCC 的影响。
A 组 5 年 HCC 累积发生率为 15.0%，高危组与 B 组的 18.2%无显著差异（P=0.17）。B 组非常早期 HCC 的检出率明显高于 A 组（P<0.001），且 CT 与超声交替监测与非常早期 HCC 的检出明显相关（风险比 3.89，P<0.001）。在中危患者中，A 组和 B 组非常早期 HCC 的检出率差异无统计学意义（P=0.30），且 CT 与超声交替监测与非常早期 HCC 的检出无明显相关性（风险比 1.61，P=0.23）。
在高危 CHB 患者中，与单纯超声检查相比，CT 与超声交替监测可提高非常早期 HCC 的检出率。
