No Association Between Screening for Hepatocellular Carcinoma and Reduced Cancer-Related Mortality in Patients With Cirrhosis [url=]Andrew M. Moon[/url]
, [url=]Noel S. Weiss[/url]
, [url=]Lauren A. Beste[/url]
, [url=]Feng Su[/url]
, [url=]Samuel B. Ho[/url]
, [url=]Ga-Young Jin[/url]
, [url=]Elliott Lowy[/url]
, [url=]Kristin Berry[/url]
, [url=]George N. Ioannou[/url][url=]Correspondence information about the author George N. Ioannou[/url]Email the author George N. Ioannou
Background & AimsScreening patients with cirrhosis for hepatocellular carcinoma (HCC) has been recommended. We conducted a matched case–control study within the US Veterans Affairs (VA) health care system to determine whether screening by abdominal ultrasonography (USS) and/or by measuring serum level of α-fetoprotein (AFP) was associated with decreased cancer-related mortality in patients with cirrhosis.
MethodsWe defined cases (n = 238) as patients with cirrhosis who died of HCC from January 1, 2013 through August 31, 2015 and had been in VA care with a diagnosis of cirrhosis for at least 4 years before the diagnosis of HCC. We matched each case to 1 control (n = 238), defined as a patient with cirrhosis who did not die of HCC and had been in VA care for at least 4 years before the date of the matched case’s HCC diagnosis. Controls were matched to cases by year of cirrhosis diagnosis, race and ethnicity, age, sex, etiology of cirrhosis, Model for End-Stage Liver Disease score, and VA medical center. We identified all USS and serum AFP tests performed within 4 years before the date of HCC diagnosis in cases or the equivalent index date in controls and determined by chart extraction (blinded to case or control status) whether these tests were performed for screening.
ResultsThere were no significant differences between cases and controls in the proportions of patients who underwent screening USS (52.9% vs 54.2%), screening measurement of serum AFP (74.8% vs 73.5%), screening USS or measurement of serum AFP (81.1% vs 79.4%), or screening USS and measurement of serum AFP (46.6% vs 48.3%) within 4 years before the index date, with or without adjusting for potential confounders. There also was no difference in receipt of these screening tests within 1, 2, or 3 years before the index date.
ConclusionsIn a matched case–control study of the VA health care system, we found that screening patients with cirrhosis for HCC by USS, measurement of serum AFP, either test, or both tests was not associated with decreased HCC-related mortality. We encourage additional case–control studies to evaluate the efficacy of screening for HCC in other health care systems, in which available records are sufficiently detailed to enable identification of the indication for USS and AFP tests.
肝硬化患者肝细胞癌筛查与癌症相关死亡率降低之间无关联
Andrew M. Moon
，Noel S. Weiss
，Lauren A. Beste
，冯苏
，Samuel B. Ho
，Ga-Young Jin
，Elliott Lowy
，克里斯汀贝瑞
，George N. Ioannou'关于作者的相关信息George N. Ioannou给作者George N. Ioannou发邮件
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DOI：https：//doi.org/10.1053/j.gastro.2018.06.079 |
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Should We Abandon Current Hepatocellular Carcinoma Screening Practices?
Gregory S. Cooper'Correspondence information about the author Gregory S. CooperEmail the author Gregory S. Cooper
Division of Gastroenterology, University Hospitals Cleveland Medical Center and Case Western Reserve University and Case Comprehensive Cancer Center, Cleveland, Ohio
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DOI: https://doi.org/10.1053/j.gastro.2018.09.001 |
See “No association between screening for hepatocellular carcinoma and reduced cancer-related mortality in patients with cirrhosis,” by Moon AM, Weiss NS, Beste LA, et al, on page 1128.
Hepatocellular carcinoma (HCC) is currently the third leading cause of cancer death worldwide1 and is the third most common and fatal gastrointestinal cancer in the United States.2 Although the estimated annual incidence of 42,000 cases in the United States is lower than several other common cancers, it is one of the few malignancies that is increasing in incidence and mortality in both men and women.2 The incidence is expected to continue to remain high owing to increases in the prevalence of certain chronic liver diseases, notably nonalcoholic fatty liver disease.3 Because survival is strongly associated with stage at diagnosis, routine surveillance with ultrasound examination with or without alpha-fetoprotein (AFP) in at-risk patients is generally recommended by all professional societies worldwide (Table 1). However, the data supporting surveillance are largely limited to observational studies, which are subject to multiple biases. A frequently cited randomized trial from China showed a 37% decrease in HCC mortality with semiannual ultrasound examinations and AFP,4 but had several methodologic concerns about randomization and follow-up, and was limited to patients with hepatitis B.5 Nonetheless, in the absence of alternative strategies, ultrasound-based surveillance is the current standard of care.
我们应该放弃目前的肝细胞癌筛查实践吗？
Gregory S. Cooper'关于作者的相关信息Gregory S. CooperEmail作者Gregory S. Cooper
美国俄亥俄州克里夫兰市大学医院克利夫兰医疗中心和凯斯西储大学消化科和病例综合癌症中心
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DOI：https：//doi.org/10.1053/j.gastro.2018.09.001 |
Correspondence information about the author George N. Ioannou[/url]
Email the author George N. Ioannou
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