Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan. Mexico City, CP 14080, Mexico; Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain. Street Villarroel, 170, L'Eixample, 08036 Barcelona, Spain; Faculty of Medicine and Health Sciences, Doctoral Program in Medicine and Translational Research, University of Barcelona, Barcelona, Spain. Street Casanova, 143, L'Eixample, 08036 Barcelona, Spain.
Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan. Mexico City, CP 14080, Mexico.
Ann Hepatol. 2024 Nov-Dec;29(6):101545. doi: 10.1016/j.aohep.2024.101545. Epub 2024 Aug 13.
The most widely used staging system for hepatocellular carcinoma (HCC) is the Barcelona Liver Clinic Cancer (BCLC) system, which considers tumor burden, performance status, and liver function. Tumor burden is assessed with cross sectional imaging of the abdomen and chest, controversy surrounds the routine use of bone scintigraphy (BS) for detecting extrahepatic metastases. This study evaluated the role of BS in staging HCC in Mexican patients.
Retrospective cross-sectional study of all adults with HCC at a Mexican referral center from 2000 to 2018. Staging included abdominal computed tomography (CT) or magnetic resonance imaging, chest CT, and BS. The main outcome was the impact of BS on staging and/or therapy plans.
Among 238 patients, 2 with fibrolamellar variant and 44 with incomplete data were excluded. Median age was 66 years, 84 % had cirrhosis, and the predominant etiology was hepatitis C virus (43 %). BCLC stages were distributed as follows: A (14 %), B (7 %), C (68 %), and D (11 %). Extrahepatic disease was present in 18 %; only 8 % patients had a positive BS. Among the positive cases, 4 were true positives, but they did not alter staging or therapy plans.
Routine BS in HCC staging demonstrated low yield, with a notable rate of false positives. Considering the implications of extrahepatic disease, BS may be justified for liver transplant candidates outside conventional criteria. Our study highlights the limited role of BS in early-stage HCC and advocates for a more selective utilization.
最广泛使用的肝细胞癌（HCC）分期系统是巴塞罗那肝脏临床癌症（BCLC）系统，该系统考虑肿瘤负担、身体状况和肝功能。肿瘤负担通过腹部和胸部的横截面成像来评估，对于常规使用骨闪烁扫描（BS）来检测肝外转移存在争议。本研究评估了 BS 在墨西哥患者 HCC 分期中的作用。
这是一项对 2000 年至 2018 年在墨西哥转诊中心就诊的所有成年 HCC 患者的回顾性横断面研究。分期包括腹部计算机断层扫描（CT）或磁共振成像、胸部 CT 和 BS。主要结果是 BS 对分期和/或治疗计划的影响。
在 238 名患者中，有 2 名纤维板层变异患者和 44 名数据不完整的患者被排除在外。中位年龄为 66 岁，84%有肝硬化，主要病因是丙型肝炎病毒（43%）。BCLC 分期分布如下：A（14%）、B（7%）、C（68%）和 D（11%）。肝外疾病的发生率为 18%；只有 8%的患者 BS 阳性。在阳性病例中，有 4 例为真阳性，但并未改变分期或治疗计划。
HCC 分期中常规 BS 的检出率较低，且假阳性率较高。考虑到肝外疾病的影响，BS 可能对超出常规标准的肝移植候选者有意义。本研究强调了 BS 在早期 HCC 中的作用有限，并主张更有选择性地使用。
