肝癌筛查:有利有弊,谨守指南
  • 肝硬化患者被推荐行超声筛查肝细胞癌(HCC),其利弊未得到量化研究;
  • 对纳入筛查的肝硬化患者跟踪5年,量化计算B超筛查的利弊;
  • 平均每筛查77人可预防1例死亡,每筛查7人就有1例假阳性;
  • 每千人中,因为假阳性,65人行不必要的CT/MRI检查,39人行不必要的穿刺活检;
  • 对肝硬化患者行常规的B超筛查,可以减少HCC的死亡率,代价是假阳性引发不必要的影像学检查及多余的穿刺活检。
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Hepatology [IF:17.425]

Modelling the benefits and harms of surveillance for hepatocellular carcinoma: information to support informed choices

数学模拟分析肝癌筛查的利弊

10.1002/hep.29315

2017-06-12, Article

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Surveillance by ultrasonography for hepatocellular carcinoma (HCC) for individuals with cirrhosis is recommended. There is debate regarding the effectiveness of surveillance in reducing mortality and there is little information on the harms available to patients considering surveillance. The aim of this study was to provide estimates of both the benefit and harms of surveillance. A Markov model was built to simulate outcomes of individuals entering surveillance. Following identification of a focal lesion by ultrasound surveillance further investigations were defined by the EASL-EORTC recall policy. Benefit and harm outcomes are expressed per 1000 patients over 5 years. For every 1000 patients in surveillance over 5 years there are 13 fewer deaths (95% confidence interval 12-14) compared with no surveillance, equating to a number needed to screen to prevent one death from HCC of 77. In comparison, many more individuals experienced harm through surveillance. For every 1000 patients, 150 (95% confidence interval 146-154) had one or more false positive tests equating to a number needed to harm from surveillance of 7. As a consequence of a false positive test, 65 individuals required at least one additional unnecessary CT scan or MRI and 39 required an unnecessary liver biopsy according to the recall policy. Surveillance benefits were sensitive to the incidence of HCC and the mortality benefit achieved by treatment. Harms were sensitive to the rates of false positive testing and the frequency of liver biopsy.
CONCLUSION: There is a balance between the small absolute mortality benefit to surveillance for HCC and the numerically more frequent harms resulting from false positive testing. Implementation of the recently revised AASLD recommendations is predicted to reduce harms from unnecessary liver biopsy. This article is protected by copyright. All rights reserved.

First Authors:
Eleanor J Taylor

Correspondence Authors:
Ian A Rowe

All Authors:
Eleanor J Taylor,Rebecca L Jones,J Ashley Guthrie,Ian A Rowe

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