澳大利亚的肝细胞癌监测:当前和未来展望。

IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Medical Journal of Australia Pub Date : 2024-09-08 DOI:10.5694/mja2.52442
Samuel Hui
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引用次数: 0

摘要

回复:1 正如 Braillon 所强调的那样,2 我们承认 2004 年对有肝硬化或无肝硬化的中国乙肝患者进行肝细胞癌 (HCC) 监测的试验存在一些方法上的局限性。我们认为这指的是 Chen 及其同事的研究,该研究发现监测可使 HCC 诊断提前,但总体死亡率并未降低。4 然而,该试验是基于 1989 年至 1995 年期间对中国乙肝患者进行的仅α-甲胎蛋白筛查。鉴于过去三十年中监测、诊断和治疗模式的巨大转变,这些结果不能推广到现代临床实践中。在缺乏更多随机试验的情况下,Braillon 表明,对于 HCC 监测的总体价值仍存在一些争议。然而,鉴于监测已成为全球公认的治疗标准,进一步的随机试验在实际操作和伦理道德上都不太可能可行。对当代观察数据的系统性回顾发现,对肝硬化患者进行 HCC 监控可及早发现疾病,并通过接受治疗提高生存率,但对监控相关危害的发生率和严重程度的研究较少。5 鉴于 HCC 监测是高危患者的既定标准护理,我们认为集中式监测计划有其可取之处。集中式监测计划不仅能改善患者的就医和接受程度,还能提供高质量的前瞻性数据,从而评估监测在澳大利亚的实际效益和危害。公共卫生的一个重要原则是优先考虑预防性护理。就 HCC 而言,我们认为,加强对其一级和二级预防的关注为改善这一毁灭性疾病的治疗效果提供了最大的机会。
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Hepatocellular carcinoma surveillance in Australia: current and future perspectives

In reply: On behalf of my co-authors, I thank Braillon for their interest in our article.1 As highlighted by Braillon,2 we accept there are some methodological limitations in the 2004 trial that investigated hepatocellular carcinoma (HCC) surveillance in Chinese hepatitis B patients with or without cirrhosis.3 Braillon also refers to an additional negative trial for HCC surveillance. We assume this is in reference to the study by Chen and colleagues, which found surveillance resulted in earlier HCC diagnosis but without a reduction in overall mortality.4 However, this trial was based on α-fetoprotein-only screening in Chinese hepatitis B patients between 1989 and 1995. These results cannot be generalised to modern clinical practice, given the considerable paradigm shift in surveillance, diagnosis and treatment over the past three decades.

In the absence of additional randomised trials, Braillon has shown that there remains some debate about the overall value of HCC surveillance. Further randomised trials are, however, unlikely to be practical or ethically feasible, given surveillance is a well established standard of care worldwide. A systematic review of contemporary observational data has found that HCC surveillance in cirrhotic patients results in early detection and improved survival due to curative treatment receipt, although the incidence and magnitude of surveillance-related harm is less well studied.5

Given HCC surveillance is an established standard of care in high risk patients, we feel there is merit in a centralised surveillance program. Beyond improving access and uptake, centralisation will provide high quality prospective data that can assess the real-world benefit and harms of surveillance in Australia.

HCC is an emerging and costly public health problem in many Western countries that remains under-recognised. An important tenet of public health is the prioritisation of preventive care. In the case of HCC, we argue that an increased focus on its primary and secondary prevention presents the greatest opportunity for improving outcomes for this devastating disease.

No relevant disclosures.

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来源期刊
Medical Journal of Australia
Medical Journal of Australia 医学-医学:内科
CiteScore
9.40
自引率
5.30%
发文量
410
审稿时长
3-8 weeks
期刊介绍: The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
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