全球肝癌筛查指南制订现状的系统综述

Current global development of screening guidelines for hepatocellular carcinoma:a systematic review

目的使用系统综述的方法对全球范围内肝癌筛查指南进行系统梳理,并根据权威机构的癌症筛查指南制订框架,对肝癌筛查制订现状进行总结和评价,从而为后续制订肝癌筛查的循证指南提供重要参考。方法系统检索多个中英文数据库和相关网站,2019年1月3日前发布的肝癌筛查指南。根据预先制订的纳入排除标准双人独立筛选文献、提取信息。对肝癌筛查指南基本信息、筛查推荐意见、证据来源等情况进行汇总描述和总结。结果目前国内外均无独立的肝癌筛查指南,只有17部肝癌临床实践指南(Clinical practice guidelines,CPG)中简要提到肝癌筛查推荐意见。各国肝癌CPG仅推荐对乙肝、丙肝、肝硬化等肝癌高危人群进行筛查;大部分肝癌CPG推荐筛查间隔为6个月;欧美最新指南均推荐使用超声进行筛查,而亚洲则推荐使用US和甲胎蛋白联合使用。目前肝癌CPG主要基于筛查人群患肝癌风险、筛查工具准确性、筛查成本等要素推荐相应筛查策略,尚未综合考虑筛查有效性、安全性等关键要素。结论目前尚无独立的肝癌筛查指南,仅在肝癌CPG中描述了筛查推荐意见。目前指南仅推荐对肝癌高危人群进行筛查,筛查间隔为6个月;欧美和亚洲指南推荐的肝癌筛查措施有所差异。建议相关机构参考国际公认的其他癌症筛查指南制订的理论框架,考虑肝癌筛查的各个环节和关键要素的特殊性,制订专用的肝癌筛查循证指南。

Objective The objective of the study was systematically summarized the current status of the hepatocellular carcinoma(HCC)screening guidelines,and evaluated the HCC screening guidelines according to the authoritative framework of cancer screening guidelines of authoritative institutions,which provided important value for the formulation of HCC screening evidence-based guidelines.Methods Literature search was conducted in multiple databases from their inception dates to January 3,2019.In addition,we sought relevant websites further was searched to identify potentially eligible studies.Two reviewers independently screened literature and extracted data.Qualitative description of the basic information,recommendations of HCC screening,source of evidence and update progress of the HCC screening guidelines was conducted.Results At present,there were no independent HCC screening guidelines worldwide.There were only 17 clinical practice HCC guidelines briefly provided the recommendation of HCC screening.Current HCC screening guidelines only recommended screening for high-risk groups of HCC.All guidelines have identified patients with chronic hepatitis B,hepatitis C and cirrhosis as high-risk groups for HCC.Most of guidelines recommended screening intervals was 6 months.The latest guidelines in Europe and the United States recommended ultrasound for screening HCC.The combination of ultrasound and AFP was recommended in the Asian guidelines.Currently,HCC screening guidelines mainly recommended screening strategies based on factors such as risk of HCC,accuracy of screening modality,screening cost,etc..The key factors such as screening efficacy and safety have not yet been considered comprehensively.Conclusions There were no independent HCC screening guidelines worldwide.Only some clinical practice HCC guidelines briefly mentioned HCC screening.Currently,the guidelines only recommend screening for high-risk groups of HCC,with a screening interval of 6 months.There are differences in screening modalities recommended by European,American and Asian guidelines for screening HCC.It is suggested that the relevant institutions should formulate the evidence-based HCC screening guidelines by referring to the theoretical framework of other authoritative other cancer screening guidelines.