Background & Aims

Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis.

Methods

Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.

Results

Thirty-two studies (comprising 13,367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% confidence interval [CI] 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR] 0.88; 95% CI 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR 0.81; 95% CI 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR 1.08; 95% CI 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%–75%) and 45% sensitivity (95% CI 30%–62%), respectively (P = .002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI 70%–92%).

Conclusions

We found ultrasound alone has a low sensitivity to detect early stage HCC in patients with cirrhosis. Addition of AFP to ultrasound significantly increases sensitivity of early HCC detection in clinical practice.

中文翻译：

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监测成像和甲胎蛋白用于肝硬化患者肝细胞癌的早期检测：一项荟萃分析。

 背景与目标

各协会指南对于监测肝硬化患者早期肝细胞癌 (HCC) 的建议有所不同。我们比较了有或没有甲胎蛋白 (AFP) 的监测成像在肝硬化患者早期检测 HCC 方面的表现。

 方法

两名评审员从 1990 年 1 月到 2016 年 8 月检索了 MEDLINE 和 SCOPUS，以确定已发表的 HCC 整体和早期检测监测策略的敏感性和特异性。使用随机效应模型的 DerSimonian 和 Laird 方法计算和比较汇总估计值。该研究是根据系统审查和荟萃分析指南的首选报告项目进行的。

 结果

32 项研究（包括 13,367 名患者）描述了使用或不使用 AFP 测量的成像检测肝硬化患者 HCC 的敏感性。超声检测任何阶段 HCC 的敏感性为 84%（95% 置信区间 [CI] 76%–92%），但早期 HCC 的敏感性仅为 47%（95% CI 33%–61%）。在比较超声与无 AFP 测量的研究中，超声检测任何阶段 HCC 的敏感性低于超声加 AFP 测量的敏感性（相对风险 [RR] 0.88；95% CI 0.83–0.93），早期 HCC 的敏感性较低与超声加 AFP 测量相比，敏感性更高（RR 0.81；95% CI 0.71–0.93）。然而，单独超声检测 HCC 的特异性高于超声加 AFP 测量（RR 1.08；95% CI 1.05-1.09）。使用 AFP 与不使用 AFP 的超声检测早期 HCC 的敏感性分别为 63% (95% CI 48%–75%) 和 45% (95% CI 30%–62%) ( P = .002)。只有 4 项研究评估了基于计算机断层扫描或磁共振图像的监测，其检测 HCC 的敏感性为 84%（95% CI 70%–92%）。

 结论

我们发现，单独使用超声检查来检测肝硬化患者的早期 HCC 的敏感性较低。在超声检查中添加 AFP 显着提高了临床实践中早期 HCC 检测的敏感性。