AFP和或肝超声在慢性乙肝患者筛查肝癌

肝胆速递

http://www.ncbi.nlm.nih.gov/pubmed/22972059##
Cochrane Database Syst Rev. 2012 Sep 12;9:CD002799.
Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B.
Aghoram R, Cai P, Dickinson JA.
Source

Department of Family Medicine, University of Calgary, 3330 Hospital drive NW, Calgary, Alberta, Canada, T2N 1M7.
Abstract
BACKGROUND:

Chronic hepatitis B virus infection is a risk factor for development of hepatocellular carcinoma. Alpha-foetoprotein and liver ultrasonography are used to screen patients with chronic hepatitis B for hepatocellular carcinoma. It is uncertain whether screening is worthwhile.
OBJECTIVES:

To determine the beneficial and harmful effects of alpha-foetoprotein or ultrasound, or both, for screening of hepatocellular carcinoma in patients with chronic hepatitis B virus infection.
SEARCH METHODS:

Electronic searches were performed until December 2011 in the Cochrane Hepato-Biliary Group Controlled Trials Register (December 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 4) in The Cochrane Library, MEDLINE (1948 to 2011), EMBASE (1980 to 2011), Science Citation Index Expanded (1900 to 2011), Chinese Medical Literature Electronic Database (WanFang Data 1998 to 2011), and Chinese Knowledge Resource Integrated Database (1994 to 2011).
SELECTION CRITERIA:

All published reports of randomised trials on screening for liver cancer were eligible for inclusion, irrespective of language of publication. Studies were excluded when the hepatitis B status was uncertain, the screening tests were not sensitive or widely-used, or when the test was used for diagnosis of hepatocellular carcinoma rather than screening.
DATA COLLECTION AND ANALYSIS:

We independently analysed all the trials considered for inclusion. We wrote to the authors of one of the trials to obtain further information.
MAIN RESULTS:

Three randomised clinical trials were included in this review. All of them had a high risk of bias. One trial was conducted in Shanghai, China. There are several published reports on this trial, in which data were presented differently. According to the 2004 trial report, participants were randomised to screening every six months with alpha-foetoprotein and ultrasonography (n = 9373) versus no screening (n = 9443). We could not draw any definite conclusions from it. A second trial was conducted in Toronto, Canada. In this trial, there were 1069 participants with chronic hepatitis B. The trial compared screening every six months with alpha-foetoprotein alone (n = 532) versus alpha-foetoprotein and ultrasound (n = 538) over a period of five years. This trial was designed as a pilot trial; the small number of participants and the rare events did not allow an effective comparison between the two modes of screening that were studied. The remaining trial, conducted in Taiwan and published as an abstract, was designed as a cluster randomised trial to determine the optimal interval for screening using alpha foetoprotein and ultrasound. Screening intervals of four months and 12 months were compared in the two groups. Further details about the screening strategy were not available. The trial reported on cumulative four-year survival, cumulative three-year incidence of hepatocellular carcinoma, and mean tumour size. The cumulative four-year survival was not significantly different between the two screening intervals. The incidence of hepatocellular cancer was higher in the four-monthly screening group. The included trials did not report on adverse events. It appears that the sensitivity and specificity of the screening modes were poor, accounting for a substantial number of false-positive and false-negative screening results.
AUTHORS' CONCLUSIONS:

There is not enough evidence to support or refute the value of alpha-foetoprotein or ultrasound screening, or both, of hepatitis B surface antigen (HBsAg) positive patients for hepatocellular carcinoma. More and better designed randomised trials are required to compare screening against no screening.

肝胆速递

Cochrane评价2012年09月12日9：CD002799。
的甲胎蛋白和/或慢性乙型肝炎患者肝脏超声检查对肝癌的筛查
蔡Aghoram R，P，：迪金森JA。
源

家庭医学科，卡尔加里大学，加拿大阿尔伯塔省卡尔加里，医院的驱动器NW，3330，T2N 1M7。
抽象
背景：

慢性乙型肝炎病毒感染是肝癌发展的一个危险因素。甲胎蛋白和肝脏B超是用来筛选肝癌与慢性乙型肝炎患者。这是不确定的，是否是值得的筛选。
目的：

要确定甲胎蛋白和超声，或两者兼而有之，而筛选的肝癌与慢性乙型肝炎病毒感染患者的有益和有害的影响。
搜索方式：

进行电子检索，直到2011年12月份，的科克伦肝胆集团，Cochrane图书馆对照试验注册（2011年12月），Cochrane中心对照试验注册（中环）（2011年第4期），MEDLINE（1948年至2011年），EMBASE （1980年至2011年），科学引文索引扩展（1900年至2011年），中国的医学文献电子数据库（万方数据2098至11年），中国知识资源综合数据库（1994年至2011年）。
选择标准：

所有公布的报告，肝癌筛查的随机试验符合纳入标准，不论语言出版。研究被排除时，B型肝炎状态是不确定的，筛选测试不敏感或广泛使用的，或当测试用于肝细胞癌的诊断，而不是筛选。
数据收集和分析：

我们独立分析所有的试验列入考虑。我们写信给作者的试验，以获得进一步的信息。
主要结果：

三项随机临床试验，包括在本次审查。所有这些具有高风险的偏见。在中国上海进行了一项试验。有几个公布的报告这项试验，其中的数据提出了不同的。根据2004年的试验报告中，参与者被随机筛选，每6个月，甲胎蛋白和超声检查组（n = 9373）与无检查组（n = 9443）。我们不能得出任何明确的结论。在加拿大多伦多进行的第二次审判。在这项试验中，共有1069参与者与慢性B型肝炎的试验，比较，筛选每6个月甲胎蛋白单独组（n = 532）与甲胎蛋白和超声组（n = 538）在一个为期五年。这项试验的目的是作为一个试验计划，少数的参与者和罕见的事件并没有让这两种模式之间进行了研究，筛选有效的比较。其余的审判，在台湾进行的，并已作为一个抽象的，目的是作为一个整群随机试验，以确定最佳的时间间隔筛查使用的阿尔法foetoprotein和超声。筛选间隔4个月和12个月进行比较​​中的两组。进一步的筛选策略的详细信息不可用。试验报告的4年累积生存率，3年累积肝细胞癌的发生率，肿瘤的平均大小。两者之间的筛查间隔的4年累积生存率并没有显着不同的。肝癌的发病率较高，在四每月筛查组。纳入的试验没有报告不良事件。它出现的筛选模式的敏感性和特异性比较差，占了相当数量的假阳性和假阴性的检查结果。
评价者结论：

没有足够的证据来支持或反驳的价值的甲胎蛋白或超声筛查，或两者，B型肝炎表面抗原（HBsAg）阳性肝癌患者。需要更多和更好的随机试验比较筛选，对无筛选。