甲胎蛋白测定在诊断肝癌在现实生活中实践：一个多中心，

StephenW

    Liver

PWE-115 Alpha-Fetoprotein Measurement in the Diagnosis of Hepatocellular Carcinoma in Real-Life Practice: A Multi-Centre, Retrospective Analysis

    K Wright1,
    E Harrod2,
    G Webb3,
    J Collier1,
    D Gorard3,
    A Evans2

+ Author Affiliations

    1Gastroenterology, John Radcliffe Hospital, Oxford
    2Gastroenterology, Royal Berkshire Hospital, Reading
    3Gastroenterology, High Wycombe Hospital, High Wycombe, UK

Abstract

Introduction In hepatocellular carcinoma (HCC), earlier diagnosisimproves outcome but the optimum method of surveillance in high-risk groups is controversial. Recent AASLD and EASL guidelines[1.2] have recommended six- monthly ultrasound surveillance (USS) alone. British guidelines[3] currently recommend combining serial alpha-fetoprotein (aFP) measurements with six-monthly USS. This study aimed to assess the role of aFP measurement in HCC surveillance programmes.

Methods This large retrospective multicentre study assessed newly diagnosed HCC over a 5-year period (2006–2011) at three centres: two general hospitals and one tertiary referral centre. Electronic and multi-disciplinary team data were reviewed.

Results 111 patients with a confirmed diagnosis of HCC were identified. Of these, 91(81.9%) were male and the median age was 69 years (range 24–87). 52(46.8%) patients with newly diagnosed HCC had established liver disease prior to diagnosis. Of these, 21(40.4%) were participating in combined USS-aFP surveillance, 2(3.8%) USS alone and 1(1.9%) aFP alone. A diagnosis of HCC was confirmed by liver biopsy in 43(38.7%), CT in 41(36.9%), MRI in 25(22.5%) and USS combined with elevated aFP in 2(1.8%).

At diagnosis, aFP was elevated in 81(73.0%), normal in 22(19.8%) and unmeasured in 8(7.2%) patients. Of those 21 diagnosed in an established surveillance programme of six- monthly USS and aFP, 17(81.0%) showed a rise in aFP. When assessing the trigger for confirmatory cross-sectional imaging ± biopsy across all data, a solely elevated aFP prompted further investigation in 11(9.9%); in those under surveillance, this number was 7(29.2%) with no abnormality detected on USS within the preceding three-month period in 6(85.7%) of these.

Conclusion These results demonstrate that a significant number of patients would have had a delayed diagnosis of HCC if aFP measurement was removed from UK screening programmes. Potential contributing factors limiting the success of USS- based screening programmes include: small lesion size, sonographer error, patient factors limiting USS accuracy (e.g. body habitus) and irregular attendance for USS. This study supports continued serial measurement of aFP in patients with liver cirrhosis in contrast to European and American guidelines.

Disclosure of Interest None Declared.

References

    Hepatology, vol. 53(3)1020–1022, Mar. 2011.

    Journal of Hepatology, vol. 56(4)908–943, Apr. 2012

    Gut, vol. 52(3)iii1-iii8, 2003.

StephenW

肝细胞癌（HCC），早前diagnosisimproves结果是有争议的，但在高危人群中的最佳的监测方法。最近AASLD，EASL指南[1.2]建议每六个月超声监视（USS）单独。英国准则[3]目前建议结合串行甲胎蛋白（AFP）测量，与6月号。这项研究的目的是评估AFP测量在肝癌监控程序的作用。

方法回顾性的多中心研究评估新诊断的肝癌的5年期间（2006-2011年），在三个中心：二级综合医院和三级转诊中心。电子和多学科团队的数据进行了审查。

结果111例确诊的肝癌进行了鉴定。其中，有91名（81.9％）为男性，平均年龄为69岁（范围24-87）。建立了52（46.8％）与新诊断的肝癌患者肝脏疾病的诊断。其中，有21名（40.4％）USS-AFP联合监测，2（3.8％）USS单独和1（1.9％）AFP单独参加。肝癌的诊断，肝活检证实，43例（38.7％），CT 41（36.9％），MRI在25（22.5％）和USS与AFP升高2（1.8％）相结合。

在诊断时，AFP升高中有81（73.0％），正常22例（19.8％），8例（7.2％）与不可测。那些21确诊六每月USS和AFP，17（81.0％）在一个既定的监控程序显示AFP上升。验证横断面成像±活检跨所有数据评估触发时，一个纯粹的AFP升高提示进一步调查，11（9.9％）;在那些监视下，这个数字为7（29.2％），无异常检测USS内上三个月期间在6（85.7％）。

结论这些结果表明，一个显着的患者数量将有一个延迟诊断为肝癌，如果AFP测量被从英国的筛查方案。潜在限制美国海军为基础的筛查方案的成功的因素包括：小病灶的大小，超声检查错误，病人因素限制USS精度（如身体体质）和不规则用于USS出席。这项研究支持对比欧洲和美国的指引肝硬化患者AFP持续串行测量。