Lee Dong Ho, Cho Heejin, Yu Su Jong, Park Min Kyung, Lee Yun Bin, Cho Eun Ju, Lee Jeong-Hoon, Kim Yoon Jun, Yoon Jung-Hwan
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Gut Liver. 2025 Sep 15;19(5):770-780. doi: 10.5009/gnl240602. Epub 2025 Sep 5.
BACKGROUND/AIMS: Current guidelines recommend biannual ultrasound for hepatocellular carcinoma (HCC) surveillance in chronic hepatitis B (CHB) patients. However, computed tomography (CT) or magnetic resonance imaging (MRI) may be used when ultrasound is inadequate. The clinical impact of these alternative modalities remains unclear.
CHB patients undergoing regular HCC surveillance were classified into two groups: ultrasound-only and alternative surveillance (CT/MRI). Patients were stratified into high- and low-risk groups using the Risk Estimation for HCC in CHB (REACH-B) score. Outcomes included 10-year overall survival (OS), HCC tumor size, Barcelona Clinic Liver Cancer (BCLC) stage at diagnosis, and OS after HCC diagnosis. Propensity score matching was applied to balance baseline characteristics.
A total of 2,024 patients were included after propensity score matching to ensure balanced baseline characteristics, with 1,012 patients in each group. OS was similar (ultrasound-only 96.0% vs alternative 96.8%; p=0.379). HCC occurred in 66 patients in each group. Alternative surveillance detected smaller HCC tumors (1.6 cm vs 2.1 cm; p<0.001) and more BCLC stage 0 cases (alternative 71.2% vs ultrasound-only 42.4%; p=0.003). The OS after HCC diagnosis was higher with alternative surveillance (83.0% vs 67.0%; p=0.025). In high-risk patients (n=970), alternative surveillance increased the OS (97.3% vs 93.6%; p=0.029) and the OS after HCC diagnosis (83.0% vs 60.6%; p=0.010). No significant differences were observed in low-risk patients.
CT/MRI-based alternative surveillance led to earlier HCC detection and improved post-diagnosis survival, particularly in high-risk CHB patients, supporting its potential role as an alternative to ultrasound in selected populations.
背景/目的：当前指南建议对慢性乙型肝炎（CHB）患者每半年进行一次超声检查以监测肝细胞癌（HCC）。然而，当超声检查不充分时，可使用计算机断层扫描（CT）或磁共振成像（MRI）。这些替代检查方式的临床影响仍不明确。
将接受常规HCC监测的CHB患者分为两组：仅超声检查组和替代监测组（CT/MRI）。使用慢性乙型肝炎患者肝细胞癌风险评估（REACH-B）评分将患者分为高风险和低风险组。研究结果包括10年总生存率（OS）、HCC肿瘤大小、诊断时的巴塞罗那临床肝癌（BCLC）分期以及HCC诊断后的OS。应用倾向评分匹配法平衡基线特征。
倾向评分匹配后共纳入2024例患者以确保基线特征平衡，每组1012例。两组的总生存率相似（仅超声检查组为96.0%，替代监测组为96.8%；p=0.379）。每组均有66例患者发生HCC。替代监测发现的HCC肿瘤较小（1.6 cm对2.1 cm；p<0.001），且BCLC 0期病例更多（替代监测组为71.2%，仅超声检查组为42.4%；p=0.003）。HCC诊断后的总生存率在替代监测组更高（83.0%对67.0%；p=0.025）。在高风险患者（n=970）中，替代监测提高了总生存率（97.3%对93.6%；p=0.029）以及HCC诊断后的总生存率（83.0%对60.6%；p=0.010）。在低风险患者中未观察到显著差异。
基于CT/MRI的替代监测可更早发现HCC并改善诊断后的生存率，尤其是在高风险CHB患者中，这支持了其在特定人群中作为超声替代检查方法的潜在作用。
