缩短肝癌筛查间隔对乙型肝炎肝硬化相关肝细胞癌患者预后的影响

Shortening liver cancer screening interval may improve the prognosis of patients with hepatitis B cirrhosis-related hepatocellular carcinoma

目的探讨缩短肝癌筛查间隔对乙型肝炎肝硬化患者早期肝细胞癌(HCC)检出情况及预后的影响,探索针对这一HCC高危人群的适宜筛查方案。方法收集2007年1月-2008年1月北京佑安医院消化中心诊治的乙型肝炎肝硬化患者310例,按其筛查时间分为间隔3个月筛查组(A组)78例和间隔6个月筛查组(B组)232例。筛查项目为血清AFP及B超,随访5年,对期间检出的HCC患者继续随访至终点(死亡或2016年12月31日)。比较2组患者HCC的检出情况和预后。2组间计量资料比较采用t检验,计数资料比较采用χ~2检验或Fisher检验;生存分析采用Kaplan-Meier法。结果 310例患者至随访5年结束累积检出HCC 73例,A组21例,B组52例;A组中巴塞罗那肝癌分期中属于早期(A期)者占66.7%(14/21),显著高于B组的15.4%(8/52)(χ~2=18.685,P<0.001)。A组行根治性治疗的患者比例显著高于B组(76.2%vs 36.5%,χ~2=9.424,P=0.002)。对检出的HCC癌患者继续随访至终点时,患者累积生存时间:A组为(66.4±8.0)个月,显著高于B组(38.1±4.5)个月(t=4.295,P=0.038);累积生存率:A组为71.4%(15/21),B组为46.2%(24/52),A组显著高于B组(χ~2=3.840,P=0.043)。结论针对乙型肝炎肝硬化患者,间隔3个月进行筛查可提高HCC早期检出率,使其获得更多可根治性治疗的机会,延长生存时间。

Objective To investigate the influence of shortening liver cancer screening interval on the detection of early - stage hepatocellu- lar carcinoma （HCC） in patients with hepatitis B cirrhosis and their prognosis, as well as proper screening schemes for such patients at a high risk of HCC. Methods A total of 310 patients with hepatitis B cirrhosis who were diagnosed and treated in Department of Gastroenterology and Hepatology, Beijing YouAn Hospital, from January 2007 to January 2008 were enrolled, and according to the screening interval, they were divided into 3 - month screening group （ group A） with 78 patients and 6 - month screening group （ group B） with 232 patients. The screening items included serum alpha - fetoprotein and ultrasound and the patients were followed up for 5 years. The patients with HCC screened out were followed up to the endpoint （death or December 31, 2016）. The detection of HCC and prognosis were compared between the two groups. The t - test was used for comparison of continuous data between groups, the chi - square test or Fisher＇s exact test was used for comparison of categorical data between groups, and the Kaplan - Meier method was used for survival analysis. Results At the end of the 5 -year follow -up, 73 patients were diagnosed with HCC, with 21 in group A and 52 in group B. Group A had a significantly higher proportion of patients with early - stage HCC （ Barcelona Clinic Liver Cancer stage A） than group B [66.7% （ 14/21 ） vs 15.4% （8/52）, X^2 = 18. 685, P 〈 0. 001 ]. Group A also had a significantly higher proportion of patients who underwent radical surgery than group B （ 76. 2% vs 36.5 % , X^2 = 9.424, P = 0. 002）. The patients with HCC were followed up to the endpoint, and compared with group B, group A had a significantly longer cumulative survival time （66.4 ± 8.0 months vs 38.1 ± 4.5 months, t = 4. 295, P = 0. 038） and a significantly higher cumulative survival rate [71.4% （15/21） vs46.2% （24/52）, X^2 =3. 840, P=0.043]. Conclusion For patients with hepatitis B cirrhosis, a 3 - month screening interval can increase the early detection rate of HCC, bring the opportunity of radical treatment for these patients, and prolong their survival time.