肝硬化患者的HCC监测

StephenW

HCC Surveillance in Patients With Cirrhosis

Hepatology (Baltimore, Md.)

TAKE-HOME MESSAGE

    This is a systematic review and meta-analysis looking at HCC surveillance in clinical practice in patients with cirrhosis. There were 29 studies with a total of 118,799 patients that met inclusion criteria. Overall, surveillance use measured as a pooled estimate was 24%, with higher rates reported in patients followed in subspecialty clinics.
    Patients with either alcohol- or NASH-related cirrhosis had lower rates of HCC surveillance.

– Natasha  VonRoenn, MD
abstract

This abstract is available on the publisher's site.
BACKGROUND AND AIMS

Hepatocellular carcinoma (HCC) surveillance is associated with early tumor detection and improved survival; however, it is often underused in clinical practice. We aimed to characterize surveillance use among patients with cirrhosis and the efficacy of interventions to increase surveillance.
APPROACH AND RESULTS

We performed a systematic literature review using the MEDLINE database from January 2010 through August 2018 to identify cohort studies evaluating HCC surveillance receipt or interventions to increase surveillance in patients with cirrhosis. A pooled estimate for surveillance receipt with 95% confidence intervals was calculated. Correlates of surveillance use were defined from each study and prespecified subgroup analyses. Twenty-nine studies, with a total of 118,799 patients, met inclusion criteria, with a pooled estimate for surveillance use of 24.0% (95% confidence interval, 18.4-30.1). In subgroup analyses, the highest surveillance receipt was reported in studies with patients enrolled from subspecialty gastroenterology/hepatology clinics and lowest in studies characterizing surveillance in population-based cohorts (73.7% versus 8.8%, P < 0.001). Commonly reported correlates of surveillance included higher receipt among patients followed by subspecialists and lower receipt among those with alcohol-associated or nonalcoholic steatohepatitis (NASH)-related cirrhosis. All eight studies (n = 5,229) evaluating interventions including patient/provider education, inreach (e.g., reminder and recall systems), and population health outreach strategies reported significant increases (range 9.4%-63.6%) in surveillance receipt.
CONCLUSIONS

HCC surveillance remains underused in clinical practice, particularly among patients with alcohol-associated or NASH-related cirrhosis and those not followed in subspecialty gastroenterology clinics. Interventions such as provider education, inreach including reminder systems, and population health outreach efforts can significantly increase HCC surveillance.

StephenW

肝硬化患者的HCC监测

肝病学（马里兰州巴尔的摩）

寄回家的消息

    这是对肝硬化患者临床实践中HCC监测的系统评价和荟萃分析。有29项研究符合入选标准，共有118,799例患者。总体而言，以汇总估算值衡量的监视使用率为24％，在专科诊所接受随访的患者中报告的使用率更高。
    患有酒精或与NASH相关的肝硬化患者的HCC监测率较低。

–医学博士Natasha VonRoenn
抽象的

该摘要可在发布者的网站上找到。
背景与目的

肝细胞癌（HCC）的监测与早期发现肿瘤和改善生存有关。但是，它在临床实践中常常没有被使用。我们旨在表征肝硬化患者的监护使用情况以及增加监护的干预措施的功效。
方法和结果

我们从2010年1月至2018年8月使用MEDLINE数据库进行了系统的文献综述，以鉴定评估HCC监测接收或增加肝硬化患者监测的干预措施的队列研究。计算出具有95％置信区间的监视接收汇总估计。从每项研究和预先指定的亚组分析中定义了监视使用的相关性。共有118,799名患者的29项研究符合纳入标准，监视使用的汇总估计为24.0％（95％置信区间为18.4-30.1）。在亚组分析中，从亚专业胃肠病学/肝病门诊就诊的患者中，监测的接受率最高，而在以人群为基础的队列中以监测为特征的研究则最低（73.7％对8.8％，P <0.001）。普遍报道的监测相关性包括：患者中，其次是专科医师，其接收率较高；以及与酒精相关或与非酒精性脂肪性肝炎（NASH）相关的肝硬化患者，其接受度较低。评估干预措施的所有八项研究（n = 5,229），包括患者/提供者的教育，影响范围（例如提醒和召回系统）以及人群健康扩展策略，均报告监测接收量显着增加（范围9.4％-63.6％）。
结论

HCC监测在临床实践中仍未得到充分利用，尤其是在酒精相关或NASH相关肝硬化患者以及在专科消化内科门诊中未进行过监测的患者。提供者教育，干预包括提醒系统在内的干预措施以及人群健康推广工作等干预措施，可以大大提高对HCC的监视。