不同肝癌筛查间隔或方式的比较效果：系统评价和荟萃分析。
Comparative effectiveness of different hepatocellular carcinoma screening intervals or modalities: a systematic review and meta-analysis.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
出版信息
Chin Med J (Engl). 2023 Jun 5;136(11):1322-1330. doi: 10.1097/CM9.0000000000002341.
BACKGROUND
Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals.
METHODS
PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio.
RESULTS
In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no significant differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% confidence interval [CI]: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group.
CONCLUSIONS
The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered.
REGISTRATION
No. CRD42020148258 at PROSPERO website ( https://www.crd.york.ac.uk/PROSPERO/ ).
背景
目前的指南建议对高危人群进行肝细胞癌（HCC）筛查。然而，尚未确定理想的 HCC 筛查间隔和筛查方式。本研究旨在比较不同模式和不同间隔的筛查效果。
方法
通过 2021 年 6 月 30 日检索了 PubMed 和其他 9 个数据库。使用风险比（RR）和 95%置信区间（CI）汇总二项结局。由于大多数合格研究仅提供生存患者的数量而不是风险比，因此还使用 RR 和 95%CI 汇总生存率。
结果
共纳入 13 项研究。两项随机对照试验（RCT）和六项队列研究比较了超声（US）筛查的筛查间隔，发现较短（3 或 4 个月）和较长（6 或 12 个月）筛查间隔在早期 HCC 比例、HCC 显著死亡率、1 年生存率方面无显著差异；与 12 个月间隔结果相比，6 个月间隔筛查显著增加了早期 HCC 的比例（RR=1.17，95%CI：1.08-1.26）和延长了 5 年生存率（RR=1.39，95%CI：1.07-1.82）。另外三项 RCT 和两项队列研究比较了肝硬化或慢性乙型肝炎中的不同筛查方式，结果表明在早期 HCC 比例（RR=0.89，95%CI：0.40-1.96）和 HCC 死亡率（RR=0.69，95%CI：0.23-2.09）方面，半年期 US 和年度计算机断层扫描（CT）筛查之间无统计学差异。半年期 US 筛查显示早期 HCC 的比例低于半年期磁共振成像（MRI）（RR=0.60，95%CI：0.37-0.97）和半年期 US 联合年度 CT（RR=1.31，95%CI：1.13-1.51）筛查。增强型 US 组的早期 HCC 比例略高于 B 型 US（RR=1.08，95%CI：1.00-1.23）组。
结论
有证据表明，6 个月可能是 US 筛查的最佳 HCC 筛查间隔。在相同的筛查间隔内，CT 和 MRI 的效果优于 US。然而，MRI 和 CT 比 US 更昂贵，而且 CT 还会增加辐射暴露的风险。应仔细考虑选择 CT 或 MRI 而不是 US。
注册
在 PROSPERO 网站（https://www.crd.york.ac.uk/PROSPERO/）上注册号为 No. CRD42020148258。
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