动态CT改善肝硬化慢​​性乙型肝炎患者肝细胞癌的检测：一

StephenW

J Gastroenterol Hepatol. 2020 Mar 28. doi: 10.1111/jgh.15046. [Epub ahead of print]
Improved Detection of Hepatocellular Carcinoma by Dynamic CT in Cirrhotic Patients With Chronic Hepatitis B: A Multi-Center Study.
Kim JH1, Kang SH2, Lee M1,3, Choi HS1, Jun BG4, Kim TS1, Choi DH1, Suk KT5, Kim MY2, Kim YD4, Cheon GJ4, Baik SK2, Kim DJ5.
Author information
Abstract
BACKGROUND & AIMS:

Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-monthly ultrasonography (US). However, sensitivities of US to detect early-stage HCC in cirrhotic patients are suboptimal. We aimed to compare overall survival and detection rates of very-early-stage HCC in 2 groups: group A, undergoing 6-monthly US versus group B, undergoing 6-monthly US alternating with dynamic computed tomography (CT).
METHODS:

This retrospective multi-center study assessed 1,235 cirrhotic patients with CHB under entecavir/tenofovir therapy from 2007 to 2016. The primary endpoint was overall survival rates between the two groups. The Cox proportional hazards model and propensity-score matching analyses were used to assess the effect of surveillance modalities on overall survival and detection of BCLC 0 HCC after balancing.
RESULTS:

During a median follow-up of 4.5 years, 10-year cumulative HCC incidence rates of 16.3% were significantly higher in group B (n=576) than 13.7% in group A (n=659; P<0.001). However, in patients with HCC, 10-year overall survival rates of 85.1% were significantly higher in group B than 65.6% in group A (P=0.001 by log-rank test). CT exam alternating with US was independently associated with reduced overall mortality (HR 0.47, P=0.02). Cumulative incidence of Barcelona Clinic Liver Cancer stage (BCLC) 0 HCC were significantly higher in group B than in group A (HR 2.82, P<0.001).
CONCLUSION:

In cirrhotic patients with CHB, dynamic CT exam alternating with US led to higher detection rates of very-early-stage HCC and benefit of overall survival compared to US exams.

This article is protected by copyright. All rights reserved.
KEYWORDS:

chronic hepatitis B; cirrhosis; hepatocellular carcinoma

PMID:
    32222111
DOI:
    10.1111/jgh.15046

StephenW

J胃肠肝素。 2020年3月28日。doi：10.1111 / jgh.15046。 [Epub提前发行]
动态CT改善肝硬化慢​​性乙型肝炎患者肝细胞癌的检测：一项多中心研究。
Kim JH1，Kang SH2，Lee M1,3，Choi HS1，Jun BG4，Kim TS1，Choi DH1，Suk KT5，Kim MY2，Kim YD4，Cheon GJ4，Baik SK2，Kim DJ5。
作者信息
抽象
背景与目的：

当前针对慢性乙型肝炎（CHB）患者的指南将接受6个月一次的超声检查（US）进行肝细胞癌（HCC）监测。但是，US检测肝硬化患者早期HCC的敏感性欠佳。我们旨在比较两组早期HCC的总生存率和检出率：A组，每6个月进行一次US与B组，每6个月进行一次US和动态计算机断层扫描（CT）交替。
方法：

这项回顾性多中心研究从2007年至2016年评估了1,235例接受恩替卡韦/替诺福韦治疗的CHB肝硬化患者。主要终点是两组之间的总体生存率。使用Cox比例风险模型和倾向评分匹配分析来评估平衡后监视方式对BCLC 0 HCC总体生存和检测的影响。
结果：

在4.5年的中位随访期间，B组（n = 576）的10年累积HCC发生率16.3％显着高于A组的13.7％（n = 659； P <0.001）。然而，在HCC患者中，B组的10年总生存率显着高于A组的65.6％（对数秩检验，P = 0.001）。与US交替进行CT检查与总体死亡率的降低独立相关（HR 0.47，P = 0.02）。 B组的巴塞罗那临床肝癌分期（BCLC）0 HCC的累积发生率显着高于A组（HR 2.82，P <0.001）。
结论：

与US检查相比，在肝硬化CHB患者中，动态CT检查与US交替检查可提高早期HCC的检出率，并提高整体生存率。

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关键字：

慢性乙型肝炎肝硬化肝细胞癌

PMID：
    32222111
DOI：
    10.1111 / jgh.15046