原发性肝癌的分层筛查与监测指南(2020版)

Guideline for stratified screening and surveillance of primary liver cancer(2020 Edition)

中国原发性肝癌(简称肝癌)年龄调整发病率呈逐年下降趋势,但肝癌发病人数占全球55%,肝癌所导致的疾病负担仍呈上升趋势,患者5年生存率无显著性提高。肝硬化和未抗病毒治疗的慢性乙型肝炎是中国肝癌的主要病因。指南推荐了适合临床实践的低危、中危、高危和极高危4个层次的肝癌风险人群辨识特征。在医院和社区人群中筛查伴肝癌风险的患者,并科学地进行分层监测。伴有肝癌风险的患者需要终生监测,指南根据风险层次推荐了不同的肝癌监测间隔和工具,对于肝癌高危人群,6个月1次腹部超声联合血清甲胎蛋白监测(常规监测);对于肝癌极高危人群,3个月1次常规监测,6~12个月增强CT或MRI检查1次,以提高早期肝癌诊断率和降低监测成本;低中危人群中,肝癌年发生率低,可延长监测间隔为1年或以上。指南部分推荐意见的成本-效益仍需要进一步评价。

The age-adjusted incidence of primary liver cancer(PLC)has been declining in China.However,PLC cases in China account for 55%globally.The disease burden is still high and the 5-year survival rate was not improved significantly in the past two decades.This guideline outlines PLC screening in the risk populations,both in hospital and community.Liver cirrhosis and chronic hepatitis B are the main causes of PLC in China.For better PLC surveillance and screening in clinical practices,it is recommended to stratify population at the risk into 4 risk levels,namely,low-risk,intermediate-risk,high-risk,and extremely high-risk.The lifelong surveillance is suggested for those at the risk of PLC.The intervals and tools for surveillance and screening are recommended based on the risk levels.Abdominal ultrasonography combined with serum alpha-fetoprotein examination(routine surveillance)every 6 months is recommended for those at a high risk of PLC.Routine surveillance every 3 months and enhanced CT/MRI examination every 6-12 months are recommended for those at an extremely high risk of PLC.The surveillance interval can be extended every 1 year or longer for those at a low-risk or at an intermediate-risk of PLC,because their annual incidence of PLC is very low.The cost-effectiveness of these recommendations remains to be evaluated.