Zoli M, Magalotti D, Bianchi G, Gueli C, Marchesini G, Pisi E
Istituto di Clinica Medica Generale e Terapia Medica, University of Bologna, Italy.
Cancer. 1996 Sep 1;78(5):977-85. doi: 10.1002/(SICI)1097-0142(19960901)78:5<977::AID-CNCR6>3.0.CO;2-9.
Contrasting data have so far been reported on the utility and efficacy of screening patients with cirrhosis for early detection of hepatocellular carcinoma (HCC). The goal of this study was to evaluate the efficacy of a regular ultrasonographic and laboratory follow-up for the early detection of small HCC, and to identify parameters correlated with a higher risk of developing HCC.
One hundred and sixty-four consecutive patients with liver cirrhosis living in Emilia Romagna, Italy, were enrolled in the period 1989-1991. All patients underwent clinical, biochemical, and ultrasonographic evaluations at entry and at 3- and 6-month intervals during follow-up.
By April 1995, 34 patients had developed HCC. In 76% of the patients, ultrasonography identified HCC when it was still single and small (< 4 cm). At discriminant, logistic regression and univariate analyses, sex and the entry concentration of alkaline phosphatase, alpha-fetoprotein, gamma-glutamyl transpeptidase, and albumin were associated with a higher risk of developing HCC, whereas at multivariate analysis (Cox's model), only sex and the entry concentration of alkaline phosphatase, albumin, and alpha-fetoprotein were independently and significantly related to the appearance of HCC.
A regular ultrasonographic follow-up, timed at 3- to 6-month intervals according to the risk of HCC development in patients with cirrhosis, allows the detection of liver carcinoma at an early stage in a high proportion of patients, possibly improving the prognosis of the disease.
迄今为止，关于对肝硬化患者进行筛查以早期发现肝细胞癌（HCC）的实用性和有效性，已有相互矛盾的数据报道。本研究的目的是评估定期超声检查和实验室随访对早期发现小肝癌的有效性，并确定与发生HCC风险较高相关的参数。
1989年至1991年期间，连续纳入了意大利艾米利亚-罗马涅地区的164例肝硬化患者。所有患者在入组时以及随访期间每隔3个月和6个月进行临床、生化和超声检查评估。
到1995年4月，34例患者发生了HCC。在76%的患者中，超声检查在HCC仍为单发且较小（<4 cm）时就检测到了。在判别分析、逻辑回归和单因素分析中，性别以及碱性磷酸酶、甲胎蛋白、γ-谷氨酰转肽酶和白蛋白的入组浓度与发生HCC的风险较高相关，而在多因素分析（Cox模型）中，只有性别以及碱性磷酸酶、白蛋白和甲胎蛋白的入组浓度与HCC的出现独立且显著相关。
根据肝硬化患者发生HCC的风险，每隔3至6个月进行一次定期超声随访，能够在很大比例的患者中早期发现肝癌，可能改善疾病的预后。
