监测可改善肝细胞癌患者的生存率：一项基于人群的前瞻性

StephenW

Med J Aust. 2018 Oct 15;209(8):348-354.
Surveillance improves survival of patients with hepatocellular carcinoma: a prospective population-based study.
Hong TP1, Gow PJ2, Fink M3, Dev A4, Roberts SK2, Nicoll A5, Lubel JS5, Kronborg I6, Arachchi N6, Ryan M7, Kemp WW8, Knight V4, Sundararajan V3, Desmond P7, Thompson AJ7, Bell SJ7.
Author information

1
    St Vincent's Hospital Melbourne, Melbourne, VIC [email protected].
2
    Austin Hospital, Melbourne, VIC.
3
    University of Melbourne, Melbourne, VIC.
4
    Monash Health, Melbourne, VIC.
5
    Eastern Health, Melbourne, VIC.
6
    Western Health, Melbourne, VIC.
7
    St Vincent's Hospital Melbourne, Melbourne, VIC.
8
    Alfred Hospital, Melbourne, VIC.

Abstract
OBJECTIVES:

To determine the factors associated with survival of patients with hepatocellular carcinoma (HCC) and the effect of HCC surveillance on survival.
DESIGN, SETTING AND PARTICIPANTS:

Prospective population-based cohort study of patients newly diagnosed with HCC in seven tertiary hospitals in Melbourne, 1 July 2012 - 30 June 2013.
MAIN OUTCOME MEASURES:

Overall survival (maximum follow-up, 24 months); factors associated with HCC surveillance participation and survival.
RESULTS:

272 people were diagnosed with incident HCC during the study period; the most common risk factors were hepatitis C virus infection (41%), alcohol-related liver disease (39%), and hepatitis B virus infection (22%). Only 40% of patients participated in HCC surveillance at the time of diagnosis; participation was significantly higher among patients with smaller median tumour size (participants, 2.8 cm; non-participants, 6.0 cm; P < 0.001) and earlier Barcelona Clinic Liver Cancer (BCLC) stage disease (A/B, 59%; C/D, 25%; P < 0.001). Participation was higher among patients with compensated cirrhosis or hepatitis C infections; it was lower among those with alcohol-related liver disease or decompensated liver disease. Median overall survival time was 20.8 months; mean survival time was 18.1 months (95% CI, 16.6-19.6 months). Participation in HCC surveillance was associated with significantly lower mortality (adjusted hazard ratio [aHR], 0.60; 95% CI, 0.38-0.93; P = 0.021), as were curative therapies (aHR, 0.33; 95% CI, 0.19-0.58). Conversely, higher Child-Pugh class, alpha-fetoprotein levels over 400 kU/L, and later BCLC disease stages were each associated with higher mortality.
CONCLUSIONS:

Survival for patients with HCC is poor, but may be improved by surveillance, associated with the identification of earlier stage tumours, enabling curative therapies to be initiated.
KEYWORDS:

Hepatitis B; Hepatitis C; Liver cirrhosis; Liver diseases, alcoholic; Liver neoplasms; Neoplasms, epidemiology; Preventive medicine; Survival analysis

PMID:
    30309301

StephenW

Med J Aust。 2018年10月15日; 209（8）：348-354。
监测可改善肝细胞癌患者的生存率：一项基于人群的前瞻性研究。
Hong TP1，Gow PJ2，Fink M3，Dev A4，Roberts SK2，Nicoll A5，Lubel JS5，Kronborg I6，Arachchi N6，Ryan M7，Kemp WW8，Knight V4，Sundararajan V3，Desmond P7，Thompson AJ7，Bell SJ7。
作者信息

1
    圣文森特医院墨尔本，墨尔本，VIC [email protected]。
2
    奥斯汀医院，墨尔本，VIC。
3
    墨尔本大学，墨尔本，VIC。
4
    蒙纳士健康，墨尔本，VIC。
五
    东部卫生，墨尔本，VIC。
6
    Western Health，墨尔本，VIC。
7
    墨尔本圣文森特医院，墨尔本，维多利亚州。
8
    维多利亚州墨尔本阿尔弗雷德医院。

抽象
目的：

确定与肝细胞癌（HCC）患者的生存相关的因素和HCC监测对生存的影响。
设计，设置和参与者：

2012年7月1日至2013年6月30日在墨尔本的七家三级医院对新诊断为HCC的患者进行的基于人群的队列研究。
主要观察指标：

总生存期（最大随访时间，24个月）;与HCC监测参与和生存相关的因素。
结果：

在研究期间，有272人被诊断患有HCC事件;最常见的危险因素是丙型肝炎病毒感染（41％），酒精相关性肝病（39％）和乙型肝炎病毒感染（22％）。在诊断时，只有40％的患者参与了HCC监测;肿瘤中位数较小的患者（参与者，2.8 cm;非参与者，6.0 cm; P <0.001）和早期巴塞罗那临床肝癌（BCLC）阶段疾病（A / B，59％; C / D）的参与率显着提高，25％; P <0.001）。代偿性肝硬化或丙型肝炎感染患者的参与率较高;在酒精相关性肝病或失代偿性肝病患者中较低。中位总生存时间为20.8个月;平均存活时间为18.1个月（95％CI，16.6-19.6个月）。参与HCC监测与死亡率显着降低（校正风险比[aHR]，0.60; 95％CI，0.38-0.93; P = 0.021），治愈性疗法（aHR，0.33; 95％CI，0.19-0.58） 。相反，较高的Child-Pugh分级，超过400 kU / L的甲胎蛋白水平以及随后的BCLC疾病分期均与较高的死亡率相关。
结论：

HCC患者的生存率很低，但可以通过监测来改善，与早期肿瘤的鉴定相关，可以启动治愈性治疗。
关键词：

乙型肝炎;丙型肝炎;肝硬化;肝病，酗酒;肝肿瘤;肿瘤，流行病学;预防医学;生存分析

结论：
    30309301