摘要
Aim:Chronic persistent hepatitis B virus carriers are generally asymptomatic until the advanced stage of the disease.The"Hepatitis B-Carrier Clinics"of Chang Gung Memorial Hospital has been using alpha-fetoprotein(AFP)and liver ultrasound for early detection of hepatocellular carcinoma(HCC)in hepatitis B surface antigen(HBsAg)carriers since 1980.Methods:We evaluated the results of surveillance between 1980 and 2012 by collecting clinic data,matched cancer registry status,and national mortality database status.Results:Of 15,235 HBsAg carriers,238 instances of HCC(1.5%or 156.2/100,000 person-years)were detected over a mean follow-up period of 10.0±7.6 years.There were more men(89.1%)and patients with liver cirrhosis(70.2%)in the HCC group(P<0.001),and both the initial and maximal alanine aminotransferase(ALT)levels were higher in this group(P<0.001).One hundred and thirty cases of HCC(54.6%)were identified during regular follow-up sessions,55(23.1%)were detected after the regular schedule had lapsed("out-of-schedule"),and 53(22.3%)were lost to follow-up completely.The mean tumor size was smaller in the regular group than in the out-of-schedule group(2.72 cm vs.4.59 cm,P<0.001),and the survival rate was higher(43.8%vs.30.9%,P<0.001).Conclusion:The incidence of HCC was relatively low in the HBsAg-Carrier Clinics cohort.Surveillance for early diagnosis of HCC improved the survival of high-risk HBsAg carriers.To ensure cost-effectiveness,we suggest using different screening strategies according to the individual risk of hepatocarcinogenesis.
基金
This research was supported by the grant from Chang Gung Memorial Hospital(CMRPG3E1121 and CIRPG3H0021).
