Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Big Data Strategy Department, National Health Insurance Service, Wonju, Korea.
Yonsei Med J. 2021 Aug;62(8):758-766. doi: 10.3349/ymj.2021.62.8.758.
To assess associations between surveillance intervals in a national hepatocellular carcinoma (HCC) surveillance program and receiving curative treatment and mortality using nationwide cohort data for Korea.
Using the National Health Insurance Service Database of Korea, we retrospectively identified 3201852 patients, the target population of the national HCC surveillance program, between 2008 and 2017. After exclusion, a total of 64674 HCC patients were divided based on surveillance intervals: never screened, ≤6 months (6M), 7-12 months (1Y), 13-24 months (2Y), and 25-36 months (3Y). Associations for surveillance interval with the chance to receive curative therapy and all-cause mortality were analyzed.
The 6M group (51.9%) received curative therapy more often than the other groups (1Y, 48.3%; 2Y, 43.8%; 3Y, 41.3%; never screened, 34.5%). Odds ratio for receiving curative therapy among the other surveillance interval groups (1Y, 0.87; 2Y, 0.76; 3Y, 0.77; never screened, 0.57; <0.001) were significantly lower than that of the 6M group. The hazard ratios (HRs) of all-cause mortality were 1.07, 1.14, and 1.37 for 2Y, 3Y, and never screened groups. The HR for the 1Y group (0.96; =0.092) was not significantly different, and it was lower (0.91; <0.001) than that of the 6M group after adjustment for lead-time bias. Curative therapy was associated with survival benefits (HR, 0.26; <0.001).
HCC surveillance, especially at a surveillance interval of 6 months, increases the chance to receive curative therapy.
利用韩国全国性队列数据评估国家肝癌（HCC）监测计划中的监测间隔与接受根治性治疗和死亡率之间的关系。
利用韩国国家健康保险服务数据库，我们回顾性地确定了 2008 年至 2017 年间 3201852 名符合国家 HCC 监测计划目标人群的患者。排除后，共 64674 例 HCC 患者根据监测间隔分为：从未筛查、≤6 个月（6M）、7-12 个月（1Y）、13-24 个月（2Y）和 25-36 个月（3Y）。分析了监测间隔与接受根治性治疗机会和全因死亡率之间的关系。
6M 组（51.9%）接受根治性治疗的比例高于其他组（1Y 组为 48.3%；2Y 组为 43.8%；3Y 组为 41.3%；从未筛查组为 34.5%）。其他监测间隔组（1Y 组，0.87；2Y 组，0.76；3Y 组，0.77；从未筛查组，0.57；<0.001）接受根治性治疗的比值比明显低于 6M 组。全因死亡率的危险比（HRs）分别为 2Y 组 1.07、3Y 组 1.14 和从未筛查组 1.37。1Y 组的 HR（0.96；=0.092）无显著差异，且经领先时间偏倚校正后低于 6M 组（0.91；<0.001）。根治性治疗与生存获益相关（HR，0.26；<0.001）。
HCC 监测，特别是 6 个月的监测间隔，增加了接受根治性治疗的机会。
