全国肝细胞癌监测对慢性肝病患者预后的影响

StephenW

全国肝细胞癌监测对慢性肝病患者预后的影响
Won Sohn 1 , Danbee Kang 2 3 , Minwoong Kang 3 4 5 , Eliseo Guallar 2 3 6 , Juhee Cho 2 3 4 , Yong-Han Paik 2 4 7 8
隶属关系
隶属关系

    1
    韩国首尔成均馆大学医学院江北三星医院内科消化内科。
    2
    韩国首尔宣均馆大学三星健康科学与技术高级研究所临床研究设计与评估系。
    3
    韩国首尔宣均馆大学医学院三星医疗中心临床流行病学中心。
    4
    韩国首尔宣均馆大学三星健康科学与技术高级研究所数字医疗保健系。
    5
    韩国国立卫生研究院精准医学系人口健康研究部，韩国清州。
    6
    美国马里兰州巴尔的摩市约翰霍普金斯公共卫生学院流行病学和韦尔奇预防、流行病学和临床研究中心。
    7
    韩国首尔成均馆大学医学院三星医疗中心内科消化内科。
    8
    韩国首尔宣均馆大学三星健康科学与技术高级研究所健康科学与技术系。

    PMID：36263667 DOI：10.3350/cmh.2022.0037

抽象的

背景/目的：本研究旨在调查使用韩国国家肝癌筛查项目进行肝细胞癌 (HCC) 监测对慢性肝病患者接受 HCC 治疗和死亡率的影响。

方法：这项来自韩国国民健康保险局的基于人群的队列研究包括从 2003 年至 2015 年收集的 1,209,825 名年龄≥40 岁的慢性乙型肝炎、慢性丙型肝炎和肝硬化患者的索赔数据。根据每 6-12 个月使用超声检查和血清甲胎蛋白的 HCC 监测对患者进行分组。研究结果是接受治愈性治疗（手术切除、射频消融或肝移植）和全因死亡率。

结果：研究人群包括 1,209,825 名患有慢性乙型肝炎、慢性丙型肝炎和肝硬化的患者（中位年龄，52.0 岁；四分位距，46-55 岁；683,902 名男性 [56.5%]）。接受 HCC 监测的参与者比例为 52.7%（n=657,889）。在 10,522,940 人年的随访中，74,433 例 HCC 发生，其中 36,006 例接受了治愈性治疗。在调整混杂因素后，监测组的 HCC 治愈性治疗比例显着高于非监测组（调整后的风险比 [HR]，5.64；95% 置信区间 [CI]，5.48-5.81）。监测组的死亡率明显低于非监测组（调整后的 HR，0.56；95% CI，0.55-0.56）。

结论：使用国家筛查计划对慢性病毒性肝炎或肝硬化患者进行 HCC 监测为 HCC 的治愈性治疗提供了更好的机会，并提高了总体生存率。

关键词：肝炎；肝细胞癌;肝硬化;全国医疗保险；公共卫生监测。

StephenW

Impact of nationwide hepatocellular carcinoma surveillance on the prognosis in patients with chronic liver disease
Won Sohn  1 , Danbee Kang  2   3 , Minwoong Kang  3   4   5 , Eliseo Guallar  2   3   6 , Juhee Cho  2   3   4 , Yong-Han Paik  2   4   7   8
Affiliations
Affiliations

    1
    Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
    2
    Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.
    3
    Center for Clinical Epidemiology, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.
    4
    Department of Digital Healthcare, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.
    5
    Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Cheongju, Korea.
    6
    Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD, USA.
    7
    Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    8
    Department of Health Science and Technology, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.

    PMID: 36263667 DOI: 10.3350/cmh.2022.0037

Abstract

Background/aims: This study aimed to investigate the effect of hepatocellular carcinoma (HCC) surveillance using the Korea National Liver Cancer Screening Program on the receipt of curative treatment for HCC and mortality in patients with chronic liver disease.

Methods: This population-based cohort study from the Korean National Health Insurance Service included 2003 to 2015 claims data collected from 1,209,825 patients aged ≥40 years with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis. Patients were divided according to HCC surveillance using ultrasonography and serum alpha-fetoprotein every 6-12 months. The study outcomes were the receipt of curative treatment (surgical resection, radiofrequency ablation, or liver transplantation) and all-cause mortality.

Results: The study population consisted of 1,209,825 patients with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis (median age, 52.0 years; interquartile range, 46-55 years; 683,902 men [56.5%]). The proportion of participants who underwent HCC surveillance was 52.7% (n=657,889). During 10,522,940 person-years of follow-up, 74,433 HCC cases developed, including 36,006 patients who underwent curative treatment. The surveillance group had a significantly higher proportion of curative treatment for HCC than the non-surveillance group after adjusting for confounding factors (adjusted hazard ratio [HR], 5.64; 95% confidence interval [CI], 5.48-5.81). The surveillance group had a significantly lower mortality rate than the non-surveillance group (adjusted HR, 0.56; 95% CI, 0.55-0.56).

Conclusion: HCC surveillance using the national screening program in patients with chronic viral hepatitis or liver cirrhosis provides better opportunity for curative treatment for HCC and improves overall survival.

Keywords: Hepatitis; Hepatocellular carcinoma; Liver cirrhosis; Nationwide healthcare insurance; Public health surveillance.

StephenW

https://www.e-cmh.org/upload/pdf/cmh-2022-0037.pdf