School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC.
Department of Gastroenterology and Hepatology, Monash Health, Melbourne, VIC.
Med J Aust. 2023 Nov 6;219(9):432-438. doi: 10.5694/mja2.52124. Epub 2023 Oct 6.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, and is increasing in incidence in Australia. For most people with cirrhosis and chronic hepatitis B, HCC screening and surveillance is recommended with 6-monthly ultrasound. However, most patients with HCC are still diagnosed outside of surveillance with incurable disease. While HCC surveillance almost certainly reduces cancer-related mortality, the potential harms of surveillance are incompletely understood. Surveillance uptake remains suboptimal in many contexts, and stems from a combination of patient, clinician and system level barriers. Improved case-finding strategies may be required to identify high risk individuals in need of surveillance, as cirrhosis and viral hepatitis are often asymptomatic. HCC prediction models and novel surveillance tools such as biomarker panels, computed tomography and magnetic resonance imaging may have a future role in personalised HCC surveillance. Analyses suggest surveillance may be cost-effective, but Australian data remain limited. A centralised HCC surveillance program may ultimately have a role in delivering improved and more equitable care.
肝细胞癌（HCC）是全球癌症相关死亡的主要原因，在澳大利亚的发病率也在上升。对于大多数患有肝硬化和慢性乙型肝炎的人，建议每 6 个月进行一次超声检查，以进行 HCC 筛查和监测。然而，大多数 HCC 患者仍在监测之外被诊断出患有无法治愈的疾病。虽然 HCC 监测几乎肯定可以降低癌症相关死亡率，但监测的潜在危害尚不完全清楚。在许多情况下，监测的接受率仍然不理想，这源于患者、临床医生和系统层面的障碍的综合影响。可能需要改进病例发现策略来识别需要监测的高危人群，因为肝硬化和病毒性肝炎通常是无症状的。HCC 预测模型和新型监测工具，如生物标志物面板、计算机断层扫描和磁共振成像，可能在个性化 HCC 监测中具有未来的作用。分析表明，监测可能具有成本效益，但澳大利亚的数据仍然有限。一个集中的 HCC 监测计划最终可能在提供更好和更公平的护理方面发挥作用。
