2293慢性乙型肝炎肝癌筛查和监控在疾病流行地区

StephenW

World J Gastroenterol. 2016 Sep 14;22(34):7806-12. doi: 10.3748/wjg.v22.i34.7806.
Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area.Ungtrakul T1, Mahidol C1, Chun-On P1, Laohapand C1, Siripongsakun S1, Worakitsitisatorn A1, Vidhayakorn S1, Boonchuay W1, Dechma J1, Sornsamdang G1, Soonklang K1, Sriprayoon T1, Tanwandee T1, Auewarakul CU1.
Author information

• 1Teerapat Ungtrakul, Chulabhorn Mahidol, Pattra Chun-on, Charlie Laohapand, Surachate Siripongsakun, Akeanong Worakitsitisatorn, Sirachat Vidhayakorn, Wariya Boonchuay, Jiraporn Dechma, Gaidganok Sornsamdang, Kamonwan Soonklang, Chirayu U Auewarakul, Chulabhorn Hospital, Laksi, Bangkok 10210, Thailand.
  

AbstractAIM: To determine the role of screening and surveillance of hepatocellular carcinoma (HCC) in treatment-naïve chronic hepatitis B (CHB) patients.
METHODS: We recruited 2293 CHB patients (both males and females; aged 20-65 years). All patients were screened and underwent surveillance using abdominal ultrasonography (AUS) and serum alpha-fetoprotein (AFP) assay every 6 mo. The diagnosis, staging and treatment of HCC followed the American Association for the Study of Liver Diseases practice guidelines and the Barcelona Clinic Liver Cancer guidelines. The exclusion criteria included: decompensated cirrhosis; a history of any cancer in the last 5 years; previous antiviral treatment for CHB; concurrent infection with hepatitis C virus or human immunodeficiency virus; a Karnofsky Performance Status score < 60%; or any medical condition preventing eligibility to complete the protocol. The prevalence and incidence rates of HCC were determined; survival rates were calculated at 3-year post HCC diagnosis. The sensitivity and specificity were calculated on a per-patient basis.
RESULTS: Among 2293 treatment-naïve CHB patients, seven cases had HCC at initial screening, giving a prevalence rate of 305 per 100000 persons; 3.3% were diagnosed with liver cirrhosis, all of which were Child-Pugh class A. With a median follow-up time of 42 (range, 3-48) mo, 10 additional cases were diagnosed with HCC, resulting in an incidence rate of 143 per 100000 persons per year. This burden was as high as that reported in other studies from East Asian countries. All HCC patients were aged ≥ 40 years. Most were at an early stage (Stage 0, A or B); 14/17 cases were successfully treated with surgical resection or radiofrequency ablation, with a high 3-year survival rate of 90%. Hemangioma was the most common focal liver lesion in CHB patients detected by AUS; the main causes of AFP elevation at the initial screening were cirrhosis, increased alanine aminotransferase level and HCC. AUS detected 16/17 HCC cases whereas AFP levels ≥ 20 μg/L at diagnosis were observed in only 7/17 patients, most with a tumor size > 5 cm. For HCC screening and surveillance, AUS had a sensitivity and specificity of 94% and 82%, respectively, whereas the sensitivity and specificity of AFP at a cut-off value of ≥ 20 μg/L were 41% and 98%, respectively. Combined use of AUS and AFP assay did not improve effectiveness.
CONCLUSION: Implementation of active screening and surveillance using AUS to detect early-stage HCC in naïve CHB patients aged ≥ 40 years in an endemic area is of benefit.


KEYWORDS: Alpha-fetoprotein; Early detection; Hepatitis B; Liver cancer; Ultrasonography

PMID:27678364DOI:10.3748/wjg.v22.i34.7806

StephenW

世界今日医学Gastroenterol。 2016年9月14日; 22（34）：7806-12。 DOI：10.3748 / wjg.v22.i34.7806。
肝癌筛查和2293慢性乙型肝炎患者监控在疾病流行地区。
Ungtrakul T1，玛希隆C1，春在P1，Laohapand C1，Siripongsakun S1，Worakitsitisatorn A1，S1 Vidhayakorn，Boonchuay W1，Dechma J1，Sornsamdang G1，Soonklang K1，Sriprayoon T1，T1 Tanwandee，Auewarakul CU1。
作者信息
2293慢性乙型肝炎肝癌筛查和2293慢性乙型肝炎患者监控在疾病流行地区
    1Teerapat Ungtrakul，朱拉蓬玛希隆，贝叶春上，查理Laohapand，Surachate Siripongsakun，Akeanong Worakitsitisatorn，Sirachat Vidhayakorn，Wariya Boonchuay，Jiraporn Dechma，Gaidganok Sornsamdang，Kamonwan Soonklang，chirayu已ūAuewarakul，朱拉蓬医院，Laksi，曼谷10210，泰国。

抽象
目标：

要确定筛选和​​肝细胞癌（HCC）的监测在治疗初治慢性乙型肝炎（CHB）患者的作用。
方法：

我们招募了2293 CHB患者（男性和女性;年龄20-65岁）。所有患者进行了筛选，并使用腹部超声（澳大利亚）和血清甲胎蛋白（AFP）的测定每6个月进行监视。诊断，分期和治疗肝癌的跟着美国肝病实践指南和巴塞罗那临床肝癌准则的研究。排除标准包括：肝硬化失代偿期;在过去5年中任何癌症史;以前的抗病毒治疗慢性乙型肝炎;丙型肝炎病毒或人体免疫缺损病毒并发感染;一个卡氏行为状态评分<60％;或任何医疗条件阻止资格来完成的协议。肝癌的患病率和发病率进行了测定;存活率在3年后肝癌诊断计算。的灵敏度和特异性分别计算对每个患者的基础。
结果：

在2293初治慢性乙肝患者7例原发性肝癌曾在最初的筛选，给每305人100000的患病率; 3.3％被诊断为肝硬化，全部为Child-Pugh分级A级的42（范围3-48）月的中位随访时间，另外10例确诊肝癌，导致发病率每143人100000每年。这种负担是一样高的东亚国家的其他研究报告。所有肝癌患者年龄在≥40年。大多数人在早期阶段（阶段0，A或B）; 14/17例成功手术切除或射频消融治疗，有90％的高3年生存率。血管瘤是由AUS检测慢性乙肝患者中最常见的肝脏局灶性病变; AFP升高在初次筛选的主要原因是肝硬化，增加谷丙转氨酶水平和肝癌。 AUS检测16/17 HCC病例而AFP水平在唯一的7/17患者中观察到≥20微克/升在诊断时，最多使用肿瘤尺寸> 5厘米。为肝癌的筛查和监测，AUS具有分别为94％和82％时，灵敏度和特异性，而在≥20微克/升的截止值的灵敏度和AFP的特异性分别为41％和98％，分别为。组合使用AUS和AFP测定并没有提高效率。
结论：

积极的筛查和监测使用AUS来检测在疾病流行地区年龄≥40年初治慢性乙肝患者早期肝癌的实施是有益的。
关键词：

甲胎蛋白;早期发现;乙型肝炎;肝癌;超声

结论：
    27678364
DOI：
    10.3748 / wjg.v22.i34.7806