肝硬化研究发现筛查，肝癌死亡率之间没有联系

StephenW

Cirrhosis study finds no link between screening, liver cancer mortality
Publish date: August 28, 2018
By
    Amy Karon
    Oncology Practice
Vitals



Key clinical point: Among patients with cirrhosis, screening for hepatocellular carcinoma was not associated with reductions in liver cancer mortality.

Major finding: Similar proportions of cases and controls were screened by abdominal ultrasonography, serum alpha-fetoprotein, or both up to 4 years before the index date and even after researchers controlled for relevant confounders.

Study details: A matched case-control study of 476 patients from the Veterans Affairs health care system.

Disclosures: Funders included the National Institutes of Health and the Veterans Affairs Clinical Science Research & Development. The investigators reported no conflicts of interest.

Source: Moon AM et al. Gastroenterology. 2018 Jul 5. doi: 10.1053/j.gastro.2018.06.079.

FROM GASTROENTEROLOGY

In a case-control study of patients with cirrhosis, screening for hepatocellular carcinoma up to 4 years prior to diagnosis was not associated with lower mortality.
cirrhosis
Copyright Sebastian Kaulitzki/Thinkstock

Similar proportions of cases and controls underwent screening with abdominal ultrasonography, serum alpha-fetoprotein (AFP) testing, or both, reported Andrew M. Moon, MD, MPH, of the University of North Carolina at Chapel Hill, and his associates. “There was also no difference in receipt of these screening tests within 1, 2, or 3 years prior to the index date,” they wrote. The report was published in Gastroenterology. The findings “[suggest] that either these screening tests or the currently available treatments [for liver cancer], or both, are suboptimal and need to be improved.”

Because cirrhosis significantly increases the risk of hepatocellular carcinoma, the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver recommend screening cirrhotic patients every 6 months with abdominal ultrasonography with or without concomitant serum AFP. But nonliver societies have not endorsed this approach, citing a lack of high-quality data. One problem is that studies have compared patients whose liver cancer was diagnosed by screening with those diagnosed after they became symptomatic, which creates a lead-time bias that inherently favors screening, Dr. Moon and his associates noted.

To help fill the evidence gap, they identified 238 patients from the Veterans Affairs health care system who had died of hepatocellular carcinoma between 2013 and 2015 and who had been diagnosed with cirrhosis at least 4 years beforehand. They compared these cases with an equal number of patients with cirrhosis who had been in VA care for a similar amount of time and had not died of hepatocellular carcinoma. Cases and controls were matched by etiology of cirrhosis, year that cirrhosis was diagnosed, race, age, sex, Model for End-Stage Liver Disease score, and VA medical center. The researchers identified screening tests by reviewing blinded medical charts.

There were no significant differences in the proportions of cases and controls who underwent screening ultrasonography (52.9% versus 54.2%, respectively), screening serum AFP (74.8% versus 73.5%), either test (81.1% versus 79.4%), or both tests (46.6% versus 48.3%) within 4 years of the index date or the matched control. The result was similar after potential confounders were controlled for and when examining shorter time frames of 1, 2, and 3 years.

It was unlikely that these results reflect delayed diagnosis of liver cancer or a lack of treatment within the VA system, the experts wrote. A total of 51.3% of cases were diagnosed with Milan criteria, which exceeds the proportion in the national Surveillance, Epidemiology, and End Results registry, they noted. None of the fatal cases underwent liver transplantation, but 66.8% received other treatments for liver cancer.

Funders included the National Institutes of Health and the Veterans Affairs Clinical Science Research & Development. The investigators reported having no conflicts of interest.

SOURCE: Moon AM et al. Gastroenterology. 2018 Jul 5. doi: 10.1053/j.gastro.2018.06.079.

StephenW

肝硬化研究发现筛查，肝癌死亡率之间没有联系
发布日期：2018年8月28日
通过
    艾米卡隆
    肿瘤学实践
命脉



关键临床要点：在肝硬化患者中，肝细胞癌筛查与肝癌死亡率降低无关。

主要发现：在指数日期之前，甚至在研究人员控制相关混杂因素之后，通过腹部超声检查，血清甲胎蛋白或两者同时筛查相似比例的病例和对照。

研究细节：对来自退伍军人事务部医疗保健系统的476名患者进行了一项匹配的病例对照研究。

披露：资助者包括美国国立卫生研究院和退伍军人事务临床科学研究与发展。调查人员报告没有利益冲突。

资料来源：Moon AM等。消化内科。 2018年7月5日doi：10.1053 / j.gastro.2018.06.079。

来自胃肠病学

在肝硬化患者的病例对照研究中，在诊断前长达4年的肝细胞癌筛查与较低的死亡率无关。
硬化
版权所有Sebastian Kaulitzki / Thinkstock

北卡罗来纳大学教堂山分校的Andrew M. Moon医学博士及其同事报告说，相似比例的病例和对照组进行了腹部超声检查，血清甲胎蛋白（AFP）检测或两者的筛查。他们写道：“在索引日期之前的1年，2年或3年内，这些筛查测试也没有差异。”该报告发表在Gastroenterology上。研究结果“[表明]这些筛查试验或目前可用的[肝癌]治疗方法或两者都不是最理想的，需要加以改进。”

由于肝硬化显着增加了肝细胞癌的风险，美国肝病研究协会，欧洲肝脏研究协会和亚太肝脏研究协会建议每6个月腹部检查一次肝硬化患者伴有或不伴随血清AFP的超声检查。但非智利社会并没有认可这种方法，理由是缺乏高质量的数据。一个问题是，研究已经将通过筛查诊断出肝癌的患者与有症状后诊断出的患者进行了比较，这产生了导致时间偏倚，这本身就有利于筛查，Moon博士及其同事指出。

为了填补证据空白，他们确定了来自退伍军人事务部医疗保健系统的238名患者，这些患者在2013年至2015年间死于肝细胞癌，并且至少在4年前被诊断出患有肝硬化。他们将这些病例与同等数量的肝硬化患者进行了比较，这些患者在VA护理中的时间相似，并且没有死于肝细胞癌。病例和对照与肝硬化的病因，确诊肝硬化的年份，种族，年龄，性别，终末期肝病模型评分和VA医疗中心相匹配。研究人员通过审查盲法医学图表确定了筛查测试。

接受筛查超声检查的病例和对照组的比例无显着差异（分别为52.9％和54.2％），筛查血清AFP（74.8％对73.5％），无论是测试（81.1％对79.4％），还是两项测试（指数日期或匹配对照的4年内）（46.6％对48.3％）。在控制潜在的混杂因素并且检查1,2和3年的较短时间框架后，结果是相似的。

专家写道，这些结果不太可能反映出肝癌的延迟诊断或VA系统内缺乏治疗。他们指出，共有51.3％的病例被诊断为米兰标准，超过了国家监测，流行病学和最终结果登记的比例。所有致命病例均未进行肝移植，但66.8％的患者接受了其他肝癌治疗。

资助者包括美国国立卫生研究院和退伍军人事务临床科学研究与发展部。调查人员报告没有利益冲突。

消息来源：Moon AM等。消化内科。 2018年7月5日doi：10.1053 / j.gastro.2018.06.079。