Tanikawa K
Second Department of Internal Medicine, Kurume University School of Medicine, Japan.
Gan To Kagaku Ryoho. 1993 May;20(7):864-70.
Most hepatocellular carcinomas (HCC) in Japan are found in chronic liver diseases with persistent infection of hepatitis B or C virus. Thus, the high risk group for HCC is evident and most small HCC, less than 2 cm in diameter, are detected by a regular follow-up of every three months using ultrasonography (US) in patients with liver cirrhosis or chronic hepatitis over 40 years of age. Approximately half of localized lesions less than 2 cm in diameter found by US are not HCC. Thus, liver biopsy using fine needles is important to make a definite diagnosis in such small lesions. The most important factor in mass survey for HCC is to select people with risk factors for HCC from the whole population. We selected people for a mass survey using US who have risk factors such as 1) abnormal liver function tests, 2) past history of liver diseases, 3) HBV or HCV carrier, 4) past history of blood transfusion, and 5) excessive drinking. About one percent of the people surveyed showed HCC. The detection rate is excellent. In future, serum tumor markers for HCC such as AFP and PIVKA-II will be useful for diagnosis of small HCC because recent studies indicate that such small HCC also produce such tumor markers in about half of the cases.
在日本，大多数肝细胞癌（HCC）都发现于患有慢性肝病且持续感染乙型或丙型肝炎病毒的患者中。因此，HCC的高危人群很明确，对于年龄超过40岁的肝硬化或慢性肝炎患者，通过每三个月进行一次超声检查（US）的定期随访，可检测出大多数直径小于2 cm的小HCC。通过US发现的直径小于2 cm的局限性病变中，约有一半并非HCC。因此，对于此类小病变，采用细针肝活检对于明确诊断很重要。HCC群体筛查中最重要的因素是从整个人口中筛选出具有HCC危险因素的人群。我们使用US对具有以下危险因素的人群进行群体筛查：1）肝功能检查异常；2）既往有肝脏疾病史；3）乙肝或丙肝携带者；4）既往有输血史；5）过度饮酒。接受调查的人群中约有1%患有HCC。检测率很高。未来，HCC的血清肿瘤标志物如甲胎蛋白（AFP）和异常凝血酶原（PIVKA-II）将有助于小HCC的诊断，因为最近的研究表明，此类小HCC在约一半的病例中也会产生此类肿瘤标志物。
