与乙型肝炎病毒相关的肝细胞癌处于晚期阶段：是否可以预

StephenW

N Z Med J. 2018 Nov 30;131(1486):27-35.
Hepatitis B virus-related hepatocellular carcinoma presenting at an advanced stage: is it preventable?
Mules T1, Gane E1, Lithgow O1, Bartlett A1, McCall J1.
Author information

1
    New Zealand Liver Unit, Auckland District Health Board, Auckland.

Abstract
AIM:

Earlier diagnosis of hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) increases treatment options and survival. The aim of this study is to evaluate which factors are associated with late presentation of HBV-related HCC.
METHOD:

This is a retrospective review of all cases of HBV-related HCC diagnosed with late-stage/incurable HCC in New Zealand between 2003 and 2017. Cases were defined as patients with a positive hepatitis B surface antigen (HBsAg), and advanced (not amenable to potentially curable treatments) HCC at initial diagnosis. Patients were categorised into four groups according to potential reasons for late presentation: no previous diagnosis of HBV infection (Group A); known HBV diagnosis but not receiving HCC surveillance (Group B); known HBV diagnosis and receiving suboptimal HCC surveillance (Group C); and known HBV diagnosis and receiving optimised HCC surveillance (Group D).
RESULTS:

A total of 368 patients were reviewed. The average age at death was 59 years, and the majority of patients were Māori (39%), Pacific (34%) or Asian (20%). The incidence of patients presenting with HBV-related advanced HCC increased from 4.5 cases to 6.3 cases per million people over the review period. Of the cases, 40% were categorised into Group A, 26% into Group B, 12% into Group C and 23% in Group D. Overall, the median survival was 138 days, and this did not change during the study period. Patients receiving optimised surveillance (Group D) survived longer (mean 469 days) than patients in Group A (90 days), Group B (145 days) or Group C (152 days) (p<0.05). Patients in Group D were more likely to be treated with transarterial chemoembolisation than patients in other groups (40% vs 15%, p<0.05).
CONCLUSION:

This study has highlighted the need for improved rates of HBV diagnosis, better follow-up of those infected and the importance of optimal HCC surveillance. In New Zealand, HBV-related HCC disproportionately affects minority ethnic groups, and given the increasing incidence, provides a potential domain to reduce health inequities.

PMID:
    30496164

StephenW

N Z Med J. 2018年11月30日; 131（1486）：27-35。
与乙型肝炎病毒相关的肝细胞癌处于晚期阶段：是否可以预防？
骡子T1，Gane E1，Lithgow O1，Bartlett A1，McCall J1。
作者信息

1
    新西兰肝脏病房，奥克兰地区健康委员会，奥克兰。

抽象
目标：

早期诊断乙型肝炎病毒（HBV）相关的肝细胞癌（HCC）可提高治疗选择和生存率。本研究的目的是评估哪些因素与HBV相关HCC的晚期表现有关。
方法：

这是对2003年至2017年间在新西兰诊断为晚期/无法治愈的HCC的所有HBV相关HCC病例的回顾性研究。病例被定义为乙型肝炎表面抗原阳性（HBsAg）和晚期（不适合）的患者可能治愈的治疗方法）HCC初诊时。根据迟发的潜在原因将患者分为四组：既往未诊断为HBV感染（A组）;已知HBV诊断但未接受HCC监测（B组）;已知HBV诊断和接受次优HCC监测（C组）;和已知的HBV诊断和接受优化的HCC监测（D组）。
结果：

共审查了368名患者。死亡的平均年龄为59岁，大多数患者为毛利人（39％），太平洋地区（34％）或亚洲人（20％）。在审查期间，患有HBV相关晚期HCC的患者的发病率从4.5例增加到每百万人6.3例。在这些病例中，40％分为A组，26％分为B组，12％分为C组，23％分为D组。总体而言，中位生存期为138天，这在研究期间没有变化。接受优化监测的患者（D组）比A组（90天），B组（145天）或C组（152天）的患者存活时间更长（平均469天）（p <0.05）。与其他组患者相比，D组患者更可能接受经动脉化疗栓塞治疗（40％vs 15％，p <0.05）。
结论：

该研究强调了提高HBV诊断率，改善受感染者随访以及最佳HCC监测重要性的必要性。在新西兰，HBV相关的HCC不成比例地影响少数民族，并且鉴于发病率的增加，它提供了减少健康不公平的潜在领域。

结论：
    30496164