晚期肝纤维化患者肝细胞癌的监测

StephenW

Surveillance for hepatocellular carcinoma in patients with advanced liver fibrosis
Angelo Sangiovanni  1 , Massimo Colombo  2
Affiliations
Affiliations

    1
    IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
    2
    Liver Center, IRCCS San Raffaele Hospital, Milan, Italy.

    PMID: 33723094 DOI: 10.4103/sjg.sjg_636_20

Abstract

Surveillance is the only pragmatic approach to improve treatment of hepatocellular carcinoma (HCC) owing to the fact that it allows detection of the tumor at an early and better curable stage. International liver societies recommend surveillance with biannual abdominal ultrasound (US) for patients with cirrhosis of any etiology because of their high risk of developing HCC. This strategy is considered cost-effective, as surveillance requires an articulated and costly set of interventions, including linkage to care of patients with an early detected tumor. However, as transition to HCC is increasingly being observed in noncirrhotic patients, the majority of which does not reach the threshold of cost effectiveness for screening. The European and Japanese liver societies elected to confine recommendations for HCC screening to noncirrhotic patients with advanced fibrosis due to hepatitis C or hepatitis B only. These latter recommendations, however, are challenged by the increasing number of patients with viral hepatitis in whom HCC risk has been attenuated but not eradicated by successful antiviral therapy. In this set of patients, entry criteria of surveillance need to be refined in the light of the suboptimal diagnostic accuracy of non invasive tests that are employed to identify the ideal candidates for surveillance.

Keywords: HCC; NAFLD; hepatitis B; hepatitis C; liver fibrosis; surveillance.

StephenW

晚期肝纤维化患者肝细胞癌的监测
安吉洛·桑乔瓦尼1，马西莫·科伦坡2
隶属关系
隶属关系

    1个
    IRCCS意大利米兰市肝病中心“胃肠病学和肝病学”胃肠病学和肝病学分会Ca'Granda Ospedale Maggiore Policlinico。
    2个
    意大利米兰IRCCS San Raffaele医院肝脏中心。

    PMID：33723094 DOI：10.4103 / sjg.sjg_636_20

抽象的

监视是改善肝细胞癌（HCC）治疗的唯一实用方法，原因是它可以在早期且可治愈的早期阶段检测出肿瘤。国际肝病学会建议对任何病因的肝硬化患者进行半年两次腹部超声（US）监测，因为他们罹患肝癌的风险很高。该策略被认为具有成本效益，因为监测需要一套明确且昂贵的干预措施，包括与早期发现肿瘤患者的护理联系起来。但是，随着越来越多的非肝硬化患者观察到向HCC的过渡，其中大多数未达到筛查的成本效益阈值。欧洲和日本的肝病学会选择将HCC筛查的建议仅限于仅由丙型肝炎或乙型肝炎引起的晚期肝纤维化的非肝硬化患者。然而，这些后继的建议受到了病毒性肝炎患者数量不断增加的挑战，这些患者的HCC风险已经降低，但不能通过成功的抗病毒治疗根除。在这组患者中，需要根据非侵入性测试的次优诊断准确性来完善监视的进入标准，而无创性测试用于确定理想的监视候选者。

关键字：HCC； NAFLD；乙型肝炎；丙型肝炎;肝纤维化监视。

newchinabok

我观察的很多长期抗病毒的，年纪大的发生hcc很多。年轻抗病毒的，发生hcc的不多。抗病毒的，肝病还会缓慢进展。感谢核苷药呀，否则我辈可能早见阎王了，上干挠素时不我待，因为抗病毒，肝病还会缓慢进展。但是干挠素对年纪大的人不太适合，年纪大的人免疫力差，干挠素转阴效果不好