肝癌高風險病人有無定期追蹤在長期存活上的差異

The Impact of Regular Surveillance of Hepatocellular Carcinoma on Overall Survival of Patients with Hepatitis B or C

慢性肝病在台灣是非常重要的公共衛生議題，它主要會造成肝硬化，甚至肝癌（Hepatocellular Carcinoma, HCC）因而導致病人的死亡。肝癌在台灣更是造成癌症死亡原因的第二位（男性第一位，女性第二位）每年奪走的大約 7,000 多人的性命。而其中，因慢性 B 型及 C 型肝炎，而引起的肝癌的病人佔了最大部份。因此，為了解有肝炎有無做定期追蹤，對於罹患肝癌的預後是否有其影響，針對肝癌病人有無定期追蹤進行研究。
本研究以回溯性之世代研究（Retrospective cohort study）方式進行，目的是探討高風險的病人（慢性 B 型或 C 型肝炎感染者），有無做定期追蹤，其罹患肝癌之預後做其存活的分析。
研究對象從台南市立醫院癌症登記中心選取 2010 年 4 月至 2013 年 3 月發生癌症的病人，依病人發現肝癌時有無定期追蹤，分為 A、B 兩組以及接受治療後之存活期做兩組之存活分析。
在這段期間內總共登錄 392 個肝癌病人，經篩選後共有 288 位病人可供做分析，其中 A 組為定期接受肝癌篩檢者，共 79 位病人，B 組為未接受篩檢者，共 209 位病人，研究結果顯示，兩組病人在肝癌期別及存活率皆有顯著差異。結論 : 對高危險病人做定期篩檢，可發現較多的早期肝癌提高治療後之存活率。

A retrospect cohort study was conducted of patients undertaking a diagnosis of hepatocellular carcinoma (HCC) between April 2010 and March 2013 at Tainan Municipal Hospital. A total of 392 HCC patients were registered during this period. After excluding non-HBV, non-HCV and those patients not receiving HCC treatment in the hospital, 288 patients were enrolled for analysis. Among them, Group A included 79 (27.4%) patients who underwent periodical surveillance and Group B including 209 (72.6%) patients without surveillance. Men with HCC outnumbered women by two times both groups. 65.8% of patients had a single tumor when first screened out in Group A, while 39.2% did in Group B. By the definition of Barcelona Clinic Liver Cancer (BCLC) classification, 85.9% of Group A patients were found to be in the early stage (stage 0 and A), while only 39% of Group B patients belonged to the early stage (p<0.001). Earlier cirrhosis stage (Child-Pugh staging) was also noted in Group A. Mean serum AFP was much higher in Group B than Group A. In comparison with Child A patients in both groups, the median survival rate was 37.8 months in Group B, while Group A patients still did not reach median survival at the end of follow-up. There were 11 patients in Group A beyond the early stage. The reasons were tumor invasion to the portal vein, multiple small nodules, and poor liver function at the time of regular surveillance. Better clinical conditions were also found in Group A which may be due to implementation of antiviral treatment for Group A patients.
The results of our study indicate regular surveillance of HCC in high risk patients might provide early detection of HCC and improve the survival of those patients.