Cottone M, Turri M, Caltagirone M, Parisi P, Orlando A, Fiorentino G, Virdone R, Fusco G, Grasso R, Simonetti R G
Clinica Medica R, Ospedale Vincenzo Cervello, Palermo, Italy.
J Hepatol. 1994 Dec;21(6):1029-34. doi: 10.1016/s0168-8278(05)80613-0.
One hundred and forty-seven patients with Child's A cirrhosis and no evidence of hepatocellular carcinoma were followed up in an 8-year prospective surveillance program with testing by ultrasound and alphafetoprotein every 6 months. Eighteen of 147 patients were HBsAg positive. Anti-hepatitis C virus antibodies were found in 103 out of 133 cases tested. Sixteen patients had a history of heavy drinking. Thirty hepatocellular carcinomas were detected during follow up. At the time of diagnosis, ultrasound detected focal lesions in all the patients whereas alphafetoprotein was below diagnostic levels. The hepatocellular carcinoma was single in 26 patients and multiple in four. The overall 8-year cumulative tumor-free rate was 69% (95% confidence interval = 58-73). The yearly hepatocellular carcinoma incidence from 1985 to 1992 was respectively 2%, 1.5%, 2%, 3%, 5%, 4.8%, 7% and 10%. The initial value of AFP > 50 ng/ml and < 400 ng/ml was significantly related to the development of hepatocellular carcinoma. This series shows that the cumulative incidence of hepatocellular carcinoma in cirrhosis in Italy is higher than previously reported, but lower than that observed in Asiatic areas. A 6-month interval for ultrasound is reasonable to detect treatable tumors. Alphafetoprotein has no value for early diagnosis, although its intermediate values (> 50 and < 400 ng/ml) may indicate the presence of undetectable cancer which will appear during the follow up, and suggests that ultrasound should be employed more frequently in patients with these values.
147例Child's A级肝硬化且无肝细胞癌证据的患者，参与了一项为期8年的前瞻性监测项目，每6个月进行一次超声和甲胎蛋白检测。147例患者中有18例HBsAg阳性。在检测的133例病例中，103例发现抗丙型肝炎病毒抗体。16例患者有大量饮酒史。随访期间检测到30例肝细胞癌。诊断时，超声在所有患者中均检测到局灶性病变，而甲胎蛋白低于诊断水平。肝细胞癌单发26例，多发4例。8年总体无瘤累积率为69%（95%置信区间=58 - 73）。1985年至1992年肝细胞癌的年发病率分别为2%、1.5%、2%、3%、5%、4.8%、7%和10%。甲胎蛋白初始值>50 ng/ml且<400 ng/ml与肝细胞癌的发生显著相关。该系列研究表明，意大利肝硬化患者肝细胞癌的累积发病率高于先前报道，但低于亚洲地区观察到的发病率。每6个月进行一次超声检查对于检测可治疗的肿瘤是合理的。甲胎蛋白对早期诊断无价值，尽管其中间值（>50且<400 ng/ml）可能表明存在随访期间会出现的不可检测到的癌症，并提示对于这些值的患者应更频繁地使用超声检查。
