从一个大队列在荷兰结果：监测肝癌与提高生存率

StephenW

Research Article
Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands

    Suzanne van Meer1, Robert A. de Man2, Minneke J. Coenraad3, Dave Sprengers2, Karin M.J. van Nieuwkerk4, Heinz-Josef Klümpen5, Peter L.M. Jansen6, Jan N.M. IJzermans7, Martijn G.H. van Oijen1, Peter D. Siersema1, Karel J. van Erpecum1, ,


Background & Aims

Effectiveness of surveillance for hepatocellular carcinoma is controversial. We here explore its effects in “real life” clinical practice.
Methods

Patients with hepatocellular carcinoma diagnosed in the period 2005–2012 in five Dutch academic centers were evaluated. Surveillance was defined as ⩾2 screening tests during three preceding years and at least one radiologic imaging test within 18 months before diagnosis.
Results

295 (27%) of 1074 cases underwent surveillance. Median time interval between last negative radiologic imaging and hepatocellular carcinoma diagnosis was 7.5 months. In the surveillance group, cirrhosis (97% vs. 60%, p <0.001) and viral hepatitis were more frequent, and non-alcoholic fatty liver disease or absence of risk factors less frequent.

In case of surveillance, tumor size was significantly smaller (2.7 vs. 6.0 cm), with lower alpha–fetoprotein levels (16 vs. 44 μg/L), earlier tumor stage (BCLC 0 and A combined: 61% vs. 21%) and resection/transplantation (34% vs. 25%) or radiofrequency ablation (23% vs. 7%) more often applied, with significantly higher 1-, 3-, and 5-year survival rates.

Survival benefit by surveillance remained significant after adjustment for lead-time bias based on assumed tumor doubling time of 90 days, but not with doubling time of ⩾120 days. In multivariate analysis, surveillance was an independent predictor for mortality (for interval ⩽9 respectively >9 months: adjusted HRs 0.51 and 0.50, 95% confidence intervals: 0.39–0.67 and 0.37–0.69).
Conclusions

Surveillance for hepatocellular carcinoma was associated with smaller tumor size, earlier tumor stage, with an impact on therapeutic strategy and was an independent predictor of survival.
Abbreviations

    HCC, Hepatocellular carcinoma; HBV, Hepatitis B virus infection; HCV, Hepatitis C virus infection; US, Ultrasound; AFP, Alpha–fetoprotein; BCLC, Barcelona Clinic Liver Cancer; RFA, Radiofrequency ablation; TACE, Transarterial chemoembolization; TARE, Transarterial radioembolization; HR, Hazard ratio; PS, Performance score

Keywords

    Hepatocellular carcinoma; Surveillance; Survival

    Corresponding author. Address: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Po BOX 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 7557004.

Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier Ireland Ltd. All rights reserved.

StephenW

研究论文
从一个大队列在荷兰结果：监测肝癌与提高生存率

    苏珊面包车Meer1，罗伯特·德男士二，Minneke J. Coenraad3，戴夫Sprengers2，卡琳MJ面包车Nieuwkerk4，海因茨 - 约瑟夫Klümpen5，彼得LM Jansen6，扬NM IJzermans7，马亭GH面包车Oijen1，彼得·Siersema1卡雷尔·J.范Erpecum1，


背景和目的

监测肝癌的有效性是有争议的。我们在这里探讨其在“现实生活”的临床实践效果。
方法

患者在诊断期间2005-2012五年荷兰学术中心肝癌进行了评价。监测期间被前三年和诊断前18个月内至少有一个影像学检查试验定义为⩾2筛选试验。
结果

对1074箱子295（27％）进行监控。去年负影像学检查和肝癌诊断的平均间隔时间为7.5个月。在监视组，肝硬化（97％对60％，p值<0.001）和病毒性肝炎更频繁，非酒精性脂肪肝疾病或不存在的风险因素较不频繁。

万一监视，肿瘤大小为显著较小（2.7与6.0中厘米），具有较低的甲胎蛋白水平（16比44微克/升），早期肿瘤分期（BCLC 0和A结合：61％对21％ ）和切除/移植（34％对25％）或射频消融（23％对7％）更频繁地适用，显著更高1-，3-，和5年生存率。

生存获益通过监控仍然基于假设的肿瘤倍增90天时间筹备时间偏差调整后显著，而与倍增⩾120天的时间。在多变量分析，监控是死亡率的独立预测因子（区间⩽9分别>9个月：调整后的HR 0.51和0.50，95％置信区间：0.39-0.67和0.37-0.69）。
结论

监视肝细胞癌用较小的肿瘤大小，肿瘤早期阶段相关联，对治疗策略产生影响，是存活的独立预测因子。
缩写

    肝癌，肝癌;乙肝病毒，乙肝病毒感染;丙型肝炎病毒，丙型肝炎病毒感染;美国，超声; AFP，甲胎蛋白; BCLC，巴塞罗那临床肝癌; RFA，射频消融; TACE，肝动脉化疗栓塞;去皮，Transarterial radioembolization; HR，风险比; PS，性能得分

关键词

    肝癌;监控;生存

    通讯作者。地址：胃肠病学和肝病，大学医学中心的乌得勒支，邮政信箱85500，3508 GA荷兰乌得勒支系。电话：+31 88 7557004。

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