肝癌监测的强度决定了在乙型肝炎流行地区存在风险的患者

StephenW

Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B‐endemic area
H. Y. Kim
J. Y. Nam
J.‐H. Lee
H. A. Lee
Y. Chang
H. Y. Lee
H. Cho
D. H. Lee
Y. Y. Cho
E. J. Cho
S. J. Yu
J. M. Lee
Y. J. Kim
J.‐H. Yoon
First published: 2 April 2018
https://doi.org/10.1111/apt.14623

H. Y. Kim and J. Y. Nam are the 2 authors who contributed equally to this study.

The Handling Editor for this article was Professor Stephen Harrison, and it was accepted for pu ... More

Background

Data are insufficient regarding the survival benefit of surveillance for hepatocellular carcinoma (HCC).
Aims

To investigate the effectiveness of HCC surveillance in a hepatitis B‐endemic population.
Methods

This retrospective cohort study included 1402 consecutive patients who were newly diagnosed with HCC between 2005 and 2012 at a single tertiary hospital in Korea. The primary endpoint was overall survival. Lead‐time and length‐time biases were adjusted (sojourn time = 140 days) and sensitivity analyses were performed.
Results

The most common aetiology was hepatitis B (80.4%). Cirrhosis was present in 78.2%. HCC was diagnosed during regular surveillance (defined as mean interval of ultrasonography <8 months, n = 834), irregular surveillance (n = 104) or nonsurveillance (n = 464). Patients in the regular surveillance group were diagnosed at earlier stages ([very] early stage, 64.4%) than the irregular surveillance (40.4%) or nonsurveillance (26.9%) groups and had more chance for curative treatments (52.4%) than the irregular surveillance (39.4%) or nonsurveillance (23.3%) groups (all P < 0.001). Mortality risk was significantly lower in the regular surveillance group (adjusted hazard ratio [aHR], 0.69; 95% [CI], 0.57‐0.83) but not in the irregular surveillance group (aHR, 0.94; 95% CI, 0.69‐1.28) compared with the nonsurveillance group after adjusting for confounding factors and lead‐time. When the subjects were restricted to cirrhotic patients or Child‐Pugh class A/B patients, similar results were obtained for mortality risk reduction between groups.
Conclusions

HCC surveillance was associated with longer survival owing to earlier diagnosis and curative treatment. Survival advantage was significant with regular surveillance but not with irregular surveillance.

StephenW

肝癌监测的强度决定了在乙型肝炎流行地区存在风险的患者的存活率
H. Y. Kim
J. Y. Nam
J.-H.背风处
H. A. Lee
Y. Chang
H. Y. Lee
H. Cho
D.H.Lee
Y. Y. Cho
E. J. Cho
S. J. Yu
J. M. Lee
Y. J. Kim
J.-H.尹
首次发布：2018年4月2日
https://doi.org/10.1111/apt.14623

H. Y. Kim和J. Y. Nam是两位作者，他们对这项研究同样做出了贡献。

这篇文章的处理编辑是斯蒂芬哈里森教授，它被接受为pu ...更多

背景

关于肝细胞癌（HCC）监测的生存益处的数据不足。
目标

调查乙型肝炎流行人群HCC监测的有效性。
方法

这项回顾性队列研究纳入了2005至2012年期间在韩国的一家三级医院新近诊断为HCC的1402例连续患者。主要终点是总体生存。交付时间和长度 - 时间偏差进行了调整（逗留时间= 140天），并进行了敏感性分析。
结果

最常见的病因是乙型肝炎（80.4％）。肝硬化出现率为78.2％。在定期监测（定义为平均超声检查间隔<8个月，n = 834），不规则监测（n = 104）或非监测（n = 464）期间诊断为HCC。定期监测组患者在早期（[非常]早期，64.4％）比不规则监测（40.4％）或非监测（26.9％），诊断治愈率更高（52.4％）监测（39.4％）或非监测（23.3％）组（均P <0.001）。定期监测组的死亡风险明显较低（调整后的危险比[aHR]，0.69; 95％[CI]，0.57-0.83），而非不规则监测组的死亡风险则不显着（aHR，0.94; 95％CI，0.69-1.28）与非监测组相比，在调整了混杂因素和交付时间之后。当受试者仅限于肝硬化患者或Child-Pugh A / B级患者时，组间死亡风险降低的结果相似。
结论

由于早期诊断和治愈性治疗，HCC监测与更长的存活率相关。经常监视生存优势显着，但不是不规则监视。

StephenW

https://onlinelibrary.wiley.com/doi/full/10.1111/apt.14623