Gillessen Johannes, Reuken Philipp, Hunyady Peter-Marton, Reichert Matthias Christian, Lothschütz Lucian, Finkelmeier Fabian, Nowka Matthias, Allo Gabriel, Kütting Fabian, Bürger Martin, Nierhoff Dirk, Steffen Hans-Michael, Schramm Christoph
University Hospital Cologne, Department of Gastroenterology and Hepatology, Cologne, Germany.
University Hospital Jena, Department of Internal Medicine IV - Gastroenterology, Hepatology, Infectious Disease, Jena, Germany.
J Clin Transl Hepatol. 2023 Jun 28;11(3):626-637. doi: 10.14218/JCTH.2022.00201. Epub 2023 Jan 4.
Hepatocellular carcinoma (HCC) surveillance in patients at risk is strongly recommended and usually performed by ultrasound (US) semiannually with or without alfa-fetoprotein (AFP) measurements. Quality parameters except for surveillance intervals have not been strictly defined. We aimed to evaluate surveillance success and risk factors for surveillance failure.
Patients with ≥1 US prior to HCC diagnosis performed at four tertiary referral hospitals in Germany between 2008 and 2019 were retrospectively analyzed. Surveillance success was defined as HCC detection within Milan criteria.
Only 47% of 156 patients, median age 63 (interquartile range: 57-70) years, 56% male, and 96% with cirrhosis, received recommended surveillance modality and interval. Surveillance failure occurred in 29% and was significantly associated with lower median model for end-stage liver disease (MELD) score odds ratio (OR) 1.154, 95% confidence interval (CI): 1.027-1.297, =0.025) and HCC localization within right liver lobe (OR: 6.083, 95% CI: 1.303-28.407, =0.022), but not with AFP ≥200 µg/L. Patients with surveillance failure had significantly more intermediate/advanced tumor stages (93% vs. 6%, <0.001), fewer curative treatment options (15% vs. 75%, <0.001) and lower survival at 1 year (54% vs. 75%, =0.041), 2 years (32% vs. 57%, =0.019) and 5 years (0% vs. 16%, =0.009). Alcoholic and non-alcoholic fatty liver disease (OR: 6.1, 95% CI: 1.7-21.3, =0.005) and ascites (OR: 3.9, 95% CI: 1.2-12.6, =0.021) were independently associated with severe visual limitations on US.
US-based HCC surveillance in patients at risk frequently fails and its failure is associated with unfavorable patient-related outcomes. Lower MELD score and HCC localization within right liver lobe were significantly associated with surveillance failure.
强烈建议对有风险的患者进行肝细胞癌（HCC）监测，通常通过超声（US）每半年进行一次，同时或不检测甲胎蛋白（AFP）。除监测间隔外，质量参数尚未严格定义。我们旨在评估监测成功率及监测失败的风险因素。
对2008年至2019年期间在德国四家三级转诊医院进行HCC诊断前接受过≥1次超声检查的患者进行回顾性分析。监测成功定义为在米兰标准内检测到HCC。
156例患者中，中位年龄63岁（四分位间距：57 - 70岁），56%为男性，96%有肝硬化，只有47%的患者接受了推荐的监测方式和间隔。29%的患者监测失败，这与较低的终末期肝病模型（MELD）评分中位数显著相关（优势比[OR] 1.154，95%置信区间[CI]：1.027 - 1.297，P = 0.025）以及HCC位于右肝叶（OR：6.083，95% CI：1.303 - 28.407，P = 0.022）有关，但与AFP≥200μg/L无关。监测失败的患者有更多的中/晚期肿瘤分期（93%对6%，P<0.001），更少的治愈性治疗选择（15%对75%，P<0.001），1年生存率更低（54%对75%，P = 0.041），2年生存率更低（32%对57%，P = 0.019），5年生存率更低（0%对16%，P = 0.009）。酒精性和非酒精性脂肪性肝病（OR：6.1，95% CI：1.7 - 21.3，P = 0.005）和腹水（OR：3.9，95% CI：1.2 - 12.6，P = 0.021）与超声检查时严重的视觉受限独立相关。
对有风险的患者进行基于超声的HCC监测经常失败，其失败与不良的患者相关结局有关。较低的MELD评分和HCC位于右肝叶与监测失败显著相关。
