Background & Aims: Hepatocellular carcinoma (HCC) presents a significant global health challenge, particularly among individuals with liver cirrhosis, with hepatitis C (HCV) a major cause. In people with HCV-related cirrhosis, an increased risk of HCC remains after cure. HCC surveillance with six monthly ultrasounds has been shown to improve survival. However, adherence to biannual screening is currently suboptimal. This study aimed to evaluate the effect of increased HCC surveillance uptake and improved ultrasound sensitivity on mortality among people with HCV-related cirrhosis post HCV cure. Methods: This study utilized mathematical modelling to assess HCC progression, surveillance, diagnosis, and treatment among individuals with cirrhosis who had successfully been treated for HCV. The deterministic compartmental model incorporated Barcelona Clinic Liver Cancer (BCLC) stages to simulate disease progression and diagnosis probabilities in 100 people with cirrhosis who had successfully been treated for hepatitis C over 10 years. Four interventions were modelled to assess their potential for improving life expectancy: realistic improvements to surveillance adherence, optimistic improvements to surveillance adherence, diagnosis sensitivity enhancements, and improved treatment efficacy Results: Realistic adherence improvements resulted in 9.8 (95% CI 7.9, 11.6) life years gained per cohort of 100 over a 10-year intervention period; 17.2 (13.9, 20.3) life years were achieved in optimistic adherence improvements. Diagnosis sensitivity improvements led to a 7.0 (3.6, 13.8) year gain in life years, and treatment improvements improved life years by 9.0 (7.5, 10.3) years. Conclusions: Regular HCC ultrasound surveillance remains crucial to reduce mortality among people with cured hepatitis C and cirrhosis. Our study highlights that even minor enhancements to adherence to ultrasound surveillance can significantly boost life expectancy across populations more effectively than strategies that increase surveillance sensitivity or treatment efficacy.
背景与目的：肝细胞癌（HCC）是全球重大健康挑战，尤其在肝硬化人群中，丙型肝炎病毒（HCV）是其主要诱因。在HCV相关肝硬化患者中，即使HCV治愈后，其HCC风险仍持续升高。每六个月进行一次超声检查的HCC监测已被证实可提高生存率。然而，目前半年期筛查的依从性仍不理想。本研究旨在评估提高HCC监测参与度和超声敏感度对HCV治愈后肝硬化患者死亡率的影响。 方法：本研究采用数学模型评估HCV成功治愈的肝硬化患者的HCC进展、监测、诊断和治疗情况。该确定性分区模型纳入巴塞罗那临床肝癌分期系统，模拟100名HCV成功治愈的肝硬化患者在10年内的疾病进展和诊断概率。通过四种干预措施模型评估其对预期寿命的改善潜力：监测依从性的现实性提升、监测依从性的乐观性提升、诊断敏感度增强以及治疗疗效改善。 结果：在10年干预期内，监测依从性现实性提升可使每100人队列获得9.8个生命年（95% CI 7.9, 11.6）；依从性乐观性提升可获得17.2个生命年（13.9, 20.3）。诊断敏感度改善带来7.0个生命年增益（3.6, 13.8），治疗改善则提升9.0个生命年（7.5, 10.3）。 结论：定期超声监测对降低HCV治愈后肝硬化患者的死亡率至关重要。本研究表明，相较于提升监测敏感度或治疗疗效的策略，即使对超声监测依从性进行微小改进，也能更有效地显著提升人群预期寿命。
肿瘤(癌症)患者之家