Larcos G, Sorokopud H, Berry G, Farrell G C
Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Sydney, NSW, Australia.
AJR Am J Roentgenol. 1998 Aug;171(2):433-5. doi: 10.2214/ajr.171.2.9694470.
The purposes of this study were to determine the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or cirrhosis and to assess the cost and benefit of sonographic screening for HCC.
We reviewed 647 sonograms of 232 patients obtained over an 8-year period. One hundred fifty-two patients had at least two sonograms. One hundred fifty-four men and 78 women with a mean age of 51 years were included. Most patients (n = 207) had biopsy-proven cirrhosis. Ethnicity, age, gender, type of liver disease, and alpha-fetoprotein levels were analyzed to determine factors associated with HCC detection. The costs of sonography and other tests were calculated using the Australian government Medicare benefits schedule.
Thirty-one patients (13%) had elevated alpha-fetoprotein levels. Liver masses were found in 25 (11%) patients. Six (2.6%) patients had HCC on biopsy (n = 3) or other tests. All cases of HCC were inoperable because of tumor multicentricity or metastases (n = 2) or both, or because of the relatively large size or poor physical condition of the patient (n = 4) or both. The only variable associated with detection of HCC was alcohol-related liver disease (p = .01). Of the six patients with HCC, one had an elevated alpha-fetoprotein level. The yearly incidence of HCC was 1.4%. Other masses shown by sonography included regenerating nodules (n = 5), hemangiomas (n = 5), focal fat sparing (n = 4), metastases (n = 2), and other lesions (n = 3). No patient underwent surgical resection, which precluded calculation of a survival benefit. The cost of our screening program was $8472 (United States dollars) per HCC. CONCLUSION. Sonographic screening is superior to alpha-fetoprotein assay for detection of HCC, but in this study, screening did not decrease mortality.
本研究旨在确定慢性肝炎或肝硬化患者肝细胞癌（HCC）的发病率，并评估超声筛查HCC的成本效益。
我们回顾了232例患者在8年期间的647份超声检查图像。152例患者至少有两份超声检查图像。纳入了154名男性和78名女性，平均年龄为51岁。大多数患者（n = 207）经活检证实患有肝硬化。分析种族、年龄、性别、肝病类型和甲胎蛋白水平，以确定与HCC检测相关的因素。超声检查和其他检查的费用根据澳大利亚政府医疗保险福利计划计算。
31例患者（13%）甲胎蛋白水平升高。25例（11%）患者发现肝脏肿块。6例（2.6%）患者经活检（n = 3）或其他检查确诊为HCC。所有HCC病例均因肿瘤多中心性或转移（n = 2）或两者兼有，或因患者肿瘤相对较大或身体状况较差（n = 4）或两者兼有而无法手术。与HCC检测相关的唯一变量是酒精性肝病（p = 0.01）。6例HCC患者中，1例甲胎蛋白水平升高。HCC的年发病率为1.4%。超声检查显示的其他肿块包括再生结节（n = 5）、血管瘤（n = 5）、局灶性脂肪缺失（n = 4）、转移瘤（n = 2）和其他病变（n = 3）。没有患者接受手术切除，因此无法计算生存获益。我们的筛查计划的成本为每例HCC 8472美元（美元）。结论。超声筛查在检测HCC方面优于甲胎蛋白检测，但在本研究中，筛查并未降低死亡率。
