對台灣肝細胞癌腹部超音波大量篩檢評估

對台灣肝細胞癌腹部超音波大量篩檢評估Evaluation of abdominal ultrasonography mass screening for hepatocellular carcinoma in Taiwan

http://onlinelibrary.wiley.com/doi/10.1002/hep.26703/abstract

腹部超音波大量篩檢，已被建議作為用來控制成人肝細胞癌（HCC）個案的一個工具，但其在降低肝細胞癌死亡率的成效從未被證實。Mass screening with abdominal ultrasonography has been suggested as a tool to control adult hepatocellular carcinoma (HCC) in individuals, but its efficacy in reducing HCC mortality has never been demonstrated. 本研究旨在透過彰化縣社區整合式篩檢（CHCIS）計劃設計依風險評分邀約高風險個案，執行腹部超音波集體篩檢肝細胞癌，評估其降低​​肝細胞癌死亡率的有效性。This study aimed to assess the effectiveness of reducing HCC mortality by mass abdominal ultrasonography (AUS) screening for HCC based on a program designed and implemented in the Changhua Community-based Integrated Screening (CHCIS) program with an efficient invitation scheme guided by the risk score. 本研究在2008 - 2010年間，從肝細胞癌高發生率地區45-69歲年齡層41,219合格受測者中，依肝細胞癌風險評分邀約11,114位合格受測者（27.0％）參加肝細胞癌腹部超音波大量篩檢評估。We invited 11,114 (27.0%) of 41,219 eligible Taiwanese subjects between 45 and 69 years of age who resided in an HCC high-incidence area to attend a risk score-guided mass abdominal ultrasonography screening between 2008 and 2010. 有效估計降低肝癌死亡率的。.The efficacy of reducing HCC mortality was estimated. 在8,962位接受肝細胞癌腹部超音波篩檢（80.6％出席率）中，確定，共有16例透過社區腹部超音波篩檢確診肝細胞癌。Of the 8,962 AUS screening attendees (with an 80.6% attendance rate), a total of 16 confirmed HCC cases were identified through community-based ultrasonography screening. 在16例肝細胞癌HCC確診病例中，只有兩例確診病例死於HCC肝癌，顯現出良好的存活率。Among the 16 screen-detected HCC cases, only two died from HCC, indicating a favorable survival.每10萬人肝細胞癌的累積死亡率在受邀參加肝細胞癌腹部超音波篩檢組（17.26例）與未受邀參加肝細胞癌腹部超音波篩檢組的每10萬人肝細胞癌的累積死亡率（42.87例）和歷史對照組的每10萬人肝細胞癌的累積死亡率（47.51例）相比是相當低的。，The cumulative mortality due to HCC (per 100,000) was considerably lower in the invited AUS group (17.26) compared with the uninvited AUS group (42.87) and the historical control group (47.51),調整年齡和性別產生的相對死亡率分別為0.69（95％CI：0.56-0.84）和0.63（95％CI：0.52-0.77）。 yielding age- and gender-adjusted relative mortality rates of 0.69 (95% CI: 0.56–0.84) and 0.63 (95% CI: 0.52-0.77), respectively.結論是，在這45-69歲未接受全國性B型肝炎病毒疫苗接種對抗B型肝炎病毒感染計劃的受測族群中，進行比較受邀參加肝細胞癌腹部超音波篩檢組，與未受邀參加肝細胞癌腹部超音波篩檢組，結果顯示在肝癌死亡率降低約31％。We concluded that the residents invited to community-based abdominal ultrasonography screening for HCC, compared with those who were not invited, showed a reduction in HCC mortality by approximately 31% among subjects aged 45–69 years who had not been included in the nationwide vaccination program against hepatitis B virus infection. (Hepatology 2013;)