Purpose:We describe the impact of screening on outcomes of patients diagnosed with hepatocellular carcinoma (HCC) in an urban safety-net healthcare system compared to a non-screened cohort diagnosed with HCC.Methods:Patients diagnosed with HCC at John Peter Smith Health Network were identified by querying the hospital tumor registry and allocated to the screened cohort if they had undergone any liver imaging within one year prior to HCC diagnosis, while the remainder were allocated to the non-screened cohort. Kaplan–Meier methods and log-rank tests were used to compare 3-year survival curves from an index date of HCC diagnosis. Cox proportional hazard models were used to calculate unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The Duffy adjustment was used to address lead-time bias.Results:A total of 158 patients were included (n = 53 screened, n = 105 non-screened). The median overall survival (OS) for the screened cohort was 19.0 months (95% CI: 9.9–NA) and that for the non-screened cohort was 5.4 months (95% CI: 3.7–8.5) [HR death (non-screened vs. screened) = 2.4, 95% CI: 1.6-3.6; log rankp< 0.0001]. The benefit of screening remained after adjusting for lead-time bias (HR 2.19, 95% CI 1.4–3.3,p= 0.0002).Conclusions:In an urban safety-net population, screening for HCC was associated with improved outcomes compared to patients diagnosed with HCC outside of a screening protocol.
目的：本研究旨在比较城市安全网医疗体系中接受筛查与未接受筛查的肝细胞癌（HCC）患者，评估筛查对患者预后的影响。 方法：通过查询约翰·彼得·史密斯健康网络的医院肿瘤登记系统，识别确诊HCC的患者。若患者在HCC诊断前一年内接受过任何肝脏影像学检查，则归入筛查队列，其余患者归入非筛查队列。采用Kaplan-Meier法和时序检验比较两组自HCC确诊日起的3年生存曲线，并运用Cox比例风险模型计算未校正及校正后的风险比（HR）及其95%置信区间（CI）。同时使用Duffy校正法处理领先时间偏倚。 结果：共纳入158例患者（筛查组53例，非筛查组105例）。筛查组中位总生存期为19.0个月（95% CI：9.9–未达到），非筛查组为5.4个月（95% CI：3.7–8.5）[非筛查组相对于筛查组的死亡风险比HR=2.4，95% CI：1.6-3.6；时序检验p<0.0001]。经领先时间偏倚校正后，筛查的生存获益仍然显著（校正后HR=2.19，95% CI：1.4–3.3，p=0.0002）。 结论：在城市安全网医疗体系中，与未遵循筛查方案确诊的HCC患者相比，接受HCC筛查与患者预后改善显著相关。
肿瘤(癌症)患者之家