肝硬化在随后确诊为肝癌

StephenW

Cirrhosis is under-recognised in patients subsequently diagnosed with hepatocellular cancer

    M. Walker1, H. B. El-Serag2,3, Y. Sada2,4, S. Mittal2,3, J. Ying2, Z. Duan2, P. Richardson2,5, J. A. Davila2,5,* andF. Kanwal2,3,*

Article first published online: 19 JAN 2016

DOI: 10.1111/apt.13505

© 2016 John Wiley & Sons Ltd

Issue
Alimentary Pharmacology & Therapeutics
Alimentary Pharmacology & Therapeutics

Volume 43, Issue 5, pages 621–630, March 2016
Article has an altmetric score of 3


    1    Department of Medicine, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    2    Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    3    Sections of Gastroenterology and Hepatology, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    4    Hematology and Oncology, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
    5    Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

* Correspondence to:
Dr F. Kanwal and Dr J. Davila, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
2002 Holcombe Blvd. (152), Houston, TX 77030, USA.
E-mails: [email protected]; [email protected]

    This article was accepted for publication after full peer-review.


Summary
Background

Most clinical practice guidelines recommend screening for HCC in patients with cirrhosis. However, patients with compensated cirrhosis are often asymptomatic and may remain unrecognised for years.
Aims

To determine the extent to which cirrhosis is unrecognised in a US Veteran population with HCC, and to evaluate the association between lack of cirrhosis recognition and stage of HCC at diagnosis.
Methods

We reviewed the electronic medical records of a random sample of HCC cases diagnosed in the national Veterans Affairs system between 2005 and 2011. We conducted multivariable analyses adjusting for patients’ demographics, comorbidity, aetiology of underlying disease and healthcare utilisation including HCC surveillance.
Results

Of 1201 patients with HCC and cirrhosis, 24.6% had unrecognised cirrhosis prior to HCC diagnosis. Older patients [>65 years, odds ratio (OR) 2.32], African Americans (OR 1.93), patients with alcoholic or NAFLD liver disease (OR 1.69 and 4.77 respectively), HIV (OR 3.02), and fewer comorbidities (Deyo 0 vs. 3, OR 2.42) had significantly higher odds of having unrecognised cirrhosis than comparison groups. Furthermore, patients with unrecognised cirrhosis were 6.5 times more likely to have advanced stage HCC at diagnosis. The effect of cirrhosis recognition on HCC stage remained significant after adjusting for pre-specified covariates (OR 3.37).
Conclusions

In one quarter of patients, cirrhosis was unrecognised prior to HCC diagnosis, and this group was significantly more likely to have advanced stage HCC. These findings emphasise the importance of timely evaluation for cirrhosis in at-risk populations as a critical step to improving outcomes for patients with HCC.

StephenW

肝硬化在随后确诊为肝癌M. Walker1，HB埃尔 - Serag2,3，Y. Sada2,4，S. Mittal2,3，J.颖2，Z. Duan2，P.理查德森2.5，JA Davila2患者根据公认5，*和F。 Kanwal2,3，*
文章首次在线发表时间：2016年1月19日
DOI：10.1111 / apt.13505
2016年©约翰·威利父子有限公司
问题
消化系统药理学和治疗
消化系统药理学和治疗
第43卷，第5期，页621-630，2016年3月
文章3 1医学系，贝勒医学院，迈克尔·狄见贝基退伍军人医疗中心，休斯敦，得克萨斯州，美国2中心的altmetric得分在质量，有效性和安全性（IQuESt），迈克尔·主动脉夹层动脉瘤退伍军人创新事务医学中心，休斯顿，德克萨斯州，美国胃肠病学和肝病，贝勒医学院，迈克尔·狄见贝基退伍军人医疗中心，休斯敦，得克萨斯州，美国4血液学和肿瘤学，贝勒医学院，迈克尔·狄见贝基的退伍军人节3事务医学中心，休斯顿，德克萨斯州，卫生服务研究的美国5科，医学系，医学，休斯敦，得克萨斯州，美国贝勒医学院
*通讯作者：
F.坎瓦尔博士和J.达维拉博士，中心在质量，有效性和安全性（IQuESt），迈克尔·狄见贝基退伍军人医疗中心，休斯顿，德克萨斯州，美国的创新
2002霍尔科姆大道。 （152），休斯顿，德克萨斯州77030，USA。
电子邮件：[email protected]; [email protected]这篇文章被接受后满同行评审的出版物。
概要
背景
大多数临床实践指南建议筛查肝癌肝硬化患者。然而，患者的代偿性肝硬化往往无症状，可能仍然无法识别多年。
目标
要确定哪个肝硬化是肝癌一个美国老将人口未确认的程度，并评估缺乏诊断肝癌肝硬化肯定和舞台之间的关联。
方法
我们回顾了HCC病例2005年至2011年间确诊的全国退伍军人事务系统随机抽样的电子病历我们进行了多变量分析调整病人的人口统计资料，合并症，潜在的疾病和医疗保健的利用，包括HCC监测的病因。
结果
1201例肝癌和肝硬化，24.6％的人之前，肝癌的诊断未被检出肝硬化。老年患者[> 65岁，比值比（OR）2.32]，非裔美国人（OR 1.93），患者（分别为OR 1.69和4.77）醇或NAFLD的肝脏疾病，艾滋病病毒（OR 3.02），和较少的合并症（Deyo 0对3，OR 2.42）有其未被检出肝硬化比对照组高显著几率。此外，患者未被检出肝硬化分别为6.5倍更有可能在诊断有晚期肝癌。对肝癌末期肝硬化识别效果调整预先指定的协变量（OR 3.37）后，仍然显著。
结论
在患者的四分之一，肝硬化肝癌被确诊之前无法识别，而这组显著更可能有晚期肝癌。这些发现强调的一个关键步骤，改善预后的肝癌患者及时评估肝硬化的高危人群的重要性。