监测成像和甲胎蛋白早期检测肝硬化患者肝细胞癌的Meta分析

StephenW

Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis
Kristina Tzartzeva∗
, Joseph Obi∗
, Nicole E. Rich
, Neehar D. Parikh
, Jorge A. Marrero
, Adam Yopp
, Akbar K. Waljee
, Amit G. Singal'Correspondence information about the author Amit G. SingalEmail the author Amit G. Singal
PlumX Metrics
DOI: https://doi.org/10.1053/j.gastro.2018.01.064 |
showArticle Info



Background & Aims

Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis.
Methods

Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.
Results

Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%–75%) and 45% sensitivity (95% CI 30%–62%), respectively (P = .002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%–92%).
Conclusions

We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.
Keywords:
Screening, Liver Cancer, Ultrasound, Alpha Fetoprotein
Abbreviations used in this paper:
AASLD (American Association for the Study of Liver Diseases), AFP (alpha fetoprotein), AUC (area under the curve), CT (computed tomography), HCC (hepatocellular carcinoma), MRI (magnetic resonance imaging), RR (relative risk)

StephenW

监测成像和甲胎蛋白早期检测肝硬化患者肝细胞癌的Meta分析
克里斯蒂娜Tzartzeva *
，约瑟夫奥比*
，Nicole E. Rich
，Neehar D. Parikh
，Jorge A. Marrero
，亚当约普
，Akbar K. Waljee
，Amit G. Singal'有关作者Amit G. Singal的电子邮件，作者Amit G. Singal发送电子邮件
PlumX指标
DOI：https：//doi.org/10.1053/j.gastro.2018.01.064 |
showArticle Info



背景和目的

社会指南在检测肝硬化患者早期肝细胞癌（HCC）的监测建议方面存在差异。我们比较了有或没有甲胎蛋白（AFP）的监测成像在肝硬化患者中早期发现HCC的表现。
方法

两位审评人员从1990年1月至2016年8月检索MEDLINE和SCOPUS，以确定公布的HCC全面和早期检测策略的敏感性和特异性。对于随机效应模型，使用DerSimonian和Laird方法计算和比较汇集的估计值。该研究按照系统评价和Meta分析指南的首选报告项目进行。
结果

32项研究（包括13,367名患者）表征了使用或不使用AFP测量对肝硬化患者HCC检测的影像学敏感性。超声检查发现任何HCC的敏感度为84％（95％置信区间[CI]为76％-92％），但早期HCC的敏感性仅为47％（95％CI 33％-61％）。在比较超声与无AFP测量的研究中，超声检测到的任何阶段的HCC的敏感性水平低于超声加AFP测量（相对风险[RR] 0.88; 95％CI 0.83-0.93）和早期HCC的低水平的灵敏度比超声加AFP测量（RR 0.81; 95％CI 0.71-0.93）。然而，超声单独检测HCC的特异性水平高于超声和AFP检测（RR 1.08; 95％CI 1.05-1.09）。超声与无AFP检测早期HCC的敏感性分别为63％（95％CI 48％-75％）和45％敏感性（95％CI 30％-62％）（P = 0.002）。只有4项研究评估计算机断层扫描或磁共振基于图像的监测，检测HCC的敏感性为84％（95％CI 70％-92％）。
结论

我们发现超声单独检测肝硬化患者早期HCC的敏感性较低。 AFP在超声中的应用显着提高了临床实践中早期HCC检测的敏感性。
关键词：
筛查，肝癌，超声波，甲胎蛋白
本文使用的缩略语：
AASLD（美国肝病研究协会），AFP（甲胎蛋白），AUC（曲线下面积），CT（计算机断层扫描），HCC（肝细胞癌），MRI（磁共振成像），RR（相对危险度）

StephenW

https://www.gastrojournal.org/ar ... a4=Gastroenterology