乙肝病毒慢性携带者中肝细胞癌的筛查：北美城市人群中肝细胞癌的发病率和患病率

Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population.

作者信息

Sherman M, Peltekian K M, Lee C

机构信息

Department of Medicine, Toronto Hospital, Ontario, Canada.

出版信息

Hepatology. 1995 Aug;22(2):432-8.

PMID:7543434

Abstract

OBJECTIVE

To prospectively determine the prevalence and annual incidence of hepatocellular carcinoma in hepatitis B carriers in a heterogeneous urban North American population and to assess the diagnostic accuracy of tests used for screening for this cancer.

DESIGN

Prospective cohort study of 1,069 chronic carriers of hepatitis B virus using screening with alpha-fetoprotein alone or in combination with ultrasonography every 6 months.

RESULTS

The mean age of the cohort was 39 +/- 12 years (+/- SD), 65% were men, 71% were Asians. At the first screening visit, serum alpha-fetoprotein was > or = 20 micrograms/L in 4%. In those subjects who were also screened by ultrasonography during the first visit, 9% were found to have focal lesions. Only 3 subjects were found to have hepatocellular carcinoma at the first screening, giving a prevalence of 281/100,000 chronic carriers of hepatitis B virus. The cohort was followed for 2,340 person-years (mean, 26 months follow-up, with a range from 6 to 60 months). During this period, 11 more subjects, 10 men and 1 woman, were diagnosed to have hepatocellular carcinoma (annual incidence, 470/100,000). In men only, the annual incidence was 657/100,000. During the study, 5 subjects died from hepatocellular carcinoma (annual mortality rate, 214/100,000). Sensitivity and specificity of serum alpha-fetoprotein > 20 micrograms/L were 64.3% and 91.4%, respectively. For ultrasonography, sensitivity was 78.8% and specificity 93.8%.

CONCLUSIONS

These data suggest that the incidence and prevalence of hepatocellular carcinoma in hepatitis B carriers in our area, an urban North American setting, are as high as in countries where hepatitis B is endemic. Current screening tests have significant false-positive and false-negative rates raising questions about the cost-benefit of screening for hepatocellular carcinoma in our study population.

摘要

目的

前瞻性确定北美一个异质性城市人群中乙肝携带者肝细胞癌的患病率和年发病率，并评估用于筛查该癌症的检测方法的诊断准确性。

设计

对1069名慢性乙肝病毒携带者进行前瞻性队列研究，每6个月单独使用甲胎蛋白或联合超声进行筛查。

结果

队列的平均年龄为39±12岁（±标准差），65%为男性，71%为亚洲人。在首次筛查时，4%的受试者血清甲胎蛋白≥20微克/升。在首次就诊时也接受超声检查的受试者中，9%发现有局灶性病变。首次筛查时仅3名受试者被发现患有肝细胞癌，乙肝病毒慢性携带者的患病率为281/10万。对该队列进行了2340人年的随访（平均随访26个月，范围为6至60个月）。在此期间，又有11名受试者被诊断患有肝细胞癌，其中10名男性和1名女性（年发病率为470/10万）。仅在男性中，年发病率为657/10万。在研究期间，5名受试者死于肝细胞癌（年死亡率为214/10万）。血清甲胎蛋白>20微克/升的敏感性和特异性分别为64.3%和91.4%。对于超声检查，敏感性为78.8%，特异性为93.8%。