Izzo F, Cremona F, Ruffolo F, Palaia R, Parisi V, Curley S A
Department of Surgical Oncology at the G. Pascale National Cancer Institute, Naples, Italy.
Ann Surg. 1998 Apr;227(4):513-8. doi: 10.1097/00000658-199804000-00011.
We performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and long-term survival rates of these HCC patients.
Chronic hepatitis B or C virus infection is a major etiologic factor in human HCC. It is not clear if routine screening of chronic viral hepatitis patients improves the survival of patients who develop HCC.
Screening for HCC was offered to patients chronically seropositive (>5 years) for hepatitis B or C infection. All patients underwent percutaneous core liver biopsy to assess the histologic severity of chronic liver injury. Patients were screened initially and every 3 months thereafter with serum alpha-fetoprotein and transabdominal ultrasound evaluations; HCC was confirmed by needle biopsy of liver tumors.
Screening was performed on 1125 hepatitis-positive patients (804 with hepatitis C, 290 with hepatitis B, 31 with both). On liver biopsy, 800 patients had mild chronic active hepatitis and 325 had severe chronic active hepatitis, cirrhosis, or both. Initial screening detected HCC in 61 patients. HCC was detected in six more patients during follow-up; thus, the incidence of HCC was 5.9% (67/1125). However, 66 of the 67 HCC cases (98.5%) arose in the 325 patients with severe chronic active hepatitis or cirrhosis (66/325 [20.3%] vs. 1/800 [0.1%], p < 0.0001 [Wilcoxon signed rank]). Median follow-up of the 67 HCC patients was 24 months. Locally advanced or metastatic, unresectable HCC occurred in 43 patients (64.2%); 24 patients (35.8%), including the 6 patients detected during follow-up screening, underwent margin-negative resection. The median survival for the 24 resected patients was 26 months, compared to 6 months for the 43 patients with unresectable cancer (p < 0.0001, Wilcoxon signed rank).
HCC was found to arise in 20.3% of patients with chronic hepatitis B or C infection and severe liver injury. Initial screening detected resectable lesions in less than half the HCC patients. Routine screening of chronic hepatitis B or C virus-infected patients with ultrasound and alpha-fetoprotein determination should be reserved for patients with severe chronic active hepatitis, cirrhosis, or both.
我们对慢性肝炎病毒感染患者进行了这项前瞻性筛查试验，以确定肝细胞癌（HCC）的发病率以及这些HCC患者的可切除性和长期生存率。
慢性乙型或丙型肝炎病毒感染是人类HCC的主要病因。目前尚不清楚对慢性病毒性肝炎患者进行常规筛查是否能提高发生HCC患者的生存率。
对慢性乙型或丙型肝炎感染血清学阳性（>5年）的患者进行HCC筛查。所有患者均接受经皮肝穿刺活检，以评估慢性肝损伤的组织学严重程度。患者最初接受筛查，此后每3个月进行血清甲胎蛋白和经腹超声评估；通过肝脏肿瘤穿刺活检确诊HCC。
对1125例肝炎阳性患者进行了筛查（丙型肝炎804例，乙型肝炎290例，两者均有的31例）。肝活检显示，800例患者患有轻度慢性活动性肝炎，325例患有重度慢性活动性肝炎、肝硬化或两者皆有。初次筛查时在61例患者中检测到HCC。随访期间又在6例患者中检测到HCC；因此，HCC的发病率为5.9%（67/1125）。然而，67例HCC病例中的66例（98.5%）出现在325例患有重度慢性活动性肝炎或肝硬化的患者中（66/325[20.3%]对1/800[0.1%]，p<0.0001[Wilcoxon符号秩检验]）。67例HCC患者的中位随访时间为24个月。43例患者（64.2%）发生局部晚期或转移性、不可切除的HCC；24例患者（35.8%），包括随访筛查中检测到的6例患者，接受了切缘阴性切除术。24例接受切除患者的中位生存期为26个月，而43例不可切除癌症患者的中位生存期为6个月（p<0.0001，Wilcoxon符号秩检验）。
发现20.3%的慢性乙型或丙型肝炎感染且肝损伤严重的患者发生了HCC。初次筛查在不到一半的HCC患者中检测到可切除病变。对慢性乙型或丙型肝炎病毒感染患者进行超声和甲胎蛋白测定的常规筛查应仅限于患有重度慢性活动性肝炎、肝硬化或两者皆有的患者。
