肝细胞癌监测：基于证据的方法。

StephenW

World J Gastroenterol. 2019 Apr 7;25(13):1550-1559. doi: 10.3748/wjg.v25.i13.1550.
Hepatocellular carcinoma surveillance: An evidence-based approach.
Harris PS1, Hansen RM1, Gray ME2, Massoud OI2, McGuire BM2, Shoreibah MG3.
Author information

1
    Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States.
2
    Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States.
3
    Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States. [email protected].

Abstract

Hepatocellular carcinoma (HCC) makes up 75%-85% of all primary liver cancers and is the fourth most common cause of cancer related death worldwide. Chronic liver disease is the most significant risk factor for HCC with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of HCC through surveillance programs improve prognosis and availability of curative therapies. All patients with cirrhosis and high-risk hepatitis B patients are at risk for HCC and should undergo surveillance. The recommended surveillance modality is abdominal ultrasound (US) given that it is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with non-alcoholic fatty liver disease (NAFLD). With the current obesity epidemic and rise in the prevalence of NAFLD, abdominal computed tomography or magnetic resonance imaging may be indicated as the primary screening modality in these patients. The addition of alpha-fetoprotein to a surveillance regimen is thought to improve the sensitivity of HCC detection. Further investigation of serum biomarkers is needed. Semiannual screening is the suggested surveillance interval. Surveillance for HCC is underutilized and low adherence disproportionately affects certain demographics such as non-Caucasian race and low socioeconomic status.
KEYWORDS:

Hepatocellular carcinoma; Liver cancer; Surveillance

PMID:
    30983815
PMCID:
    PMC6452232
DOI:
    10.3748/wjg.v25.i13.1550

StephenW

World J Gastroenterol。 2019年4月7日; 25（13）：1550-1559。 doi：10.3748 / wjg.v25.i13.1550。
肝细胞癌监测：基于证据的方法。
Harris PS1，Hansen RM1，Grey ME2，Massoud OI2，McGuire BM2，Shoreibah MG3。
作者信息

1
    Tinsley Harrison内科住院医师，阿拉巴马大学医学系，伯明翰，伯明翰，AL 35294，United States。
2
    阿拉巴马大学医学系消化内科和肝脏病学科，伯明翰，伯明翰，AL 35294，美国。
3
    阿拉巴马大学医学系消化内科和肝脏病学科，伯明翰，伯明翰，AL 35294，美国。 [email protected]。

抽象

肝细胞癌（HCC）占所有原发性肝癌的75％-85％，是全球癌症相关死亡的第四大常见原因。慢性肝病是HCC最重要的危险因素，80％-90％的新病例发生在肝硬化的背景下。研究表明，通过监测程序对HCC进行早期诊断可以改善预后和治疗方法的可用性。所有肝硬化和乙型肝炎高危患者都有患HCC的风险，应接受监测。推荐的监测方式是腹部超声（US），因为它具有成本效益且无创，灵敏度高。然而，美国在肥胖患者和非酒精性脂肪性肝病（NAFLD）患者中受到限制。随着目前的肥胖流行和NAFLD患病率的上升，腹部计算机断层扫描或磁共振成像可能被指示为这些患者的主要筛查方式。在监测方案中加入甲胎蛋白被认为可以提高HCC检测的灵敏度。需要进一步研究血清生物标志物。半年筛查是建议的监测间隔。对HCC的监测未充分利用，低依从性不成比例地影响某些人口统计数据，如非高加索人种和低社会经济地位。
关键词：

肝细胞癌;肝癌;监控

结论：
    30983815
PMCID：
    PMC6452232
DOI：
    10.3748 / wjg.v25.i13.1550