Efficacy of Hepatocellular Carcinoma Screening with Abdominal Ultrasonography for Family Relatives of Index Cases

肝癌指標個案家族成員之腹部超音波篩檢效益評估

廖朝聖(Chao-Sheng Liao) ； 陳秀熙(Hsiu-Hsi Chen) ； 陳立昇(Li-Sheng Chen) ； 嚴明芳(Amy Ming-Fang Yen) ； 邱月暇(Yueh-Hsia Chiu) ； 王鐳鴒(Lei-Ling Wang) ； 林月詩(Yueh-Shih Lin) ； 張鴻俊(Hung-Chuen Chang) ； 楊國卿(Kuo-Ching Yang)

《臺灣消化醫學雜誌》 28卷4期 (2011/12) Pp. 322-330

https://doi.org/10.6557/GJT.201112_28(4).0001

摘要

研究動機：利用肝癌病患為指標個案，以其家族成員提供腹部超音波檢查可能做為另一有效早期偵測肝癌之篩檢策略。藉由一個以醫院為主體所實行包含乳癌、大腸直腸癌及肝癌高危險族群之台灣多中心癌症篩檢計畫中，對於利用指標個案界定高危險群並提供腹部超音波篩檢，本研究欲探討此項篩檢策略之長期存活表現，以及調整相關因子與前導期偏差後是否對肝癌死亡率降低有所影響。研究材料及方法：本研究邀請來自多家醫院所診斷之肝癌個案其一等親或二等親內之家屬共20348名個案，於1992年至1997年間接受腹部超音波篩檢服務，並追蹤15年之肝癌死亡情形。本研究除呈現不同肝癌偵測方式下之累積存活狀況，並利用比例危險迴歸模型估算因篩檢所致之肝癌死亡率改變。結果：此篩檢世代之肝癌個案，整體而言，其1年、3年、5年、10年及15年肝癌存活率分別為65%、48%、40.3%、32.8%及30.9%。此外，臨床偵測個案包含篩檢間隔及篩檢後個案，其存活均較篩檢偵測個案要差。就篩檢效益而言，在考量前導期偏差校正、親等別及其他相關生化環境因子之後，本研究發現相較於篩檢後個案，於篩檢期間偵測之個案其肝癌死亡率約降低27%（95%信賴區間：1%-46%）。結論：本研究發現針對具肝癌家族病史之個案提供腹部超音波之篩檢，可以降低約30%肝癌死亡率。因此，對於這些高危險族群要必要提供更為密集的超音波檢查，以提高偵測率。

關鍵字

肝癌 ； 超音波篩檢

並列摘要

Background and Aim: The invitation of family relatives of index Hepatocellular Carcinoma (HCC) cases to undergo Ultrasonography (US) examination may provide an alternative approach to be efficient in detection of HCC at early stage. It is of great interest to report long-term survival by detection modes and also the efficacy of US in reducing mortality from HCC with adjustment for other significant factors and lead-time using the data from Taiwan Multicentre Cancer Screening (TAMCAS) project that is a screening program for three cancers (breast, colorectal, and liver cancer). For liver cancer screening program, family relatives of index HCC cases were invited to have the uptake of ultrasound screening. We aimed to assess the efficacy of ultrasound screening for first-and second-degree relatives of HCC index cases.Materials and Methods: A total of 20,348 first- or second-degree relatives of patients with HCC diagnosed in multiple hospitals were enrolled between 1992 and 1997 has been followed up over 15 years since 1992. Cumulative survival rates of HCC by detection modes are presented. We used Cox proportional hazards regression models to assess the efficacy of US in reducing mortality from HCC.Results: The 1-year, 3-year, 5-year, 10-year and 15-year case-specific survival (CSS) rates of patients with HCC were 65%, 48%, 40.3%, 32.8% and 30.9%, respectively. Clinically-detected HCC cases (including interval cancer and post-screening cancer) had lower survival than screen-detected HCC cases. By comparing the hazard rate of the screened group (screen-detected cases plus interval cancers) with that of post-screening group, the efficacy of screening with ultrasonography conferred a 27% (95% confidence interval: 1%-46%)) reduction in mortality from HCC after adjusting for other biological factors, degrees of relative relationship and lead-time.Conclusions: Our study reveals ultrasound screening for family members of HCC cases can lead to a third of mortality reduction, which suggests the intensive screening seems necessary for first-degree or second-degree of family relatives of HCC index cases.

並列關鍵字

hepatocellular carcinoma ； ultrasonography screening