HCC surveillance underused in most patients with cirrhosis; screening improvements needed
超过80%的肝硬化患者没有充分利用肝细胞癌监测，缺乏临床医嘱和患者缺乏依从性被认为是常见的筛查障碍。according to a study inJAMA Network Open.
“We found that screening attainment with semiannual, or even annual, ultrasound was low,”Neehar D. Parikh, MD, MS,study co-author and assistant professor of gastroenterology and hepatology at the University of Michigan, Ann Arbor, told Healio. “We found common barriers included lack of screening order, lack of patient follow-up for screening and nearly 18% of patients hadunrecognized cirrhosisprior to HCC diagnosis.”
为了描述HCC监测的障碍，Parikh和同事回顾性研究了5个美国医疗中心(包括3个三级护理转诊中心、1个安全网中心和1个退伍军人健康管理局医院)629名肝硬化和新诊断的HCC患者的数据。使用ICD-9和ICD-10编码和肿瘤委员会报告清单确定HCC的状态，并使用美国肝病协会标准确定诊断。研究人员在HCC诊断前12 - 36个月评估了初级保健或肝病诊所的HCC监测情况。
The median age of the patient cohort was 63.6 years and 78.1% were men. The group included 54.1% white patients, 28% Black patients and 13.1% Hispanic patients.
Researchers reported 63.7% of patients had nosurveillance prior to HCC diagnosis, 22.3% underwent annual surveillance and 14% had semiannual surveillance. Lack of surveillance orders or patient nonadherence were cited as reasons for not having surveillance in 82.4% of cases, while 17.6% had undiagnosed cirrhosis at HCC presentation.
In addition, semiannual surveillance was linked withhepatitis B infection(OR = 3.06; 95% CI, 1.24-7.23) and inversely linked with Black race (OR = 0.41; 95% CI, 0.2-0.8) and unrecognized cirrhosis (OR = 0.14; 95% CI, 0.02-0.46).
Although semiannual surveillance was significantly associated with curative treatment (OR = 2.73; 95% CI, 1.6-4.7), it was not linked with overall survival (HR = 0.81; 95% CI, 0.55-1.18).
“The most surprising finding was that screening was not associated with early detection or overall survival but was associated with curative treatment receipt,” Parikh said. “These patients were, by definition, followed with regular medical care and a high proportion (75.4%) of patients were found to have their HCC on a screening test, even though many did not have regular annual or semiannual screening prior to their diagnosis of HCC.”
Further, researchers wrote that they observed “significant site-level variation in surveillance attainment, highlighting particular opportunities to target interventions at low-performing sites or patients at high risk of surveillance failure.”
“The study speaks to the need to improvescreening programs for hepatocellular carcinomaby targeting ordering, patient completion of screening tests and improving recognition of cirrhosis,” Parikh said.