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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2020; 74(5): 380–385. doi:10.14735/amgh2020380.

Surveillance hepatocelulárneho karcinómu na Slovensku

Svetlana Adamcová-Selčanová1, Ľubomír Skladaný1, Jana Čiefová1, Sylvia Dražilová2, Tomáš Koller3, Peter Jarčuška4,5, Miroslav Žigrai5

+ Pracoviště

Souhrn

Úvod:
Viaceré štúdie preukázali, že surveillance hepatocelulárneho karcinómu (HCC) vďaka včasnej dia­gnostike a liečbe znižuje mortalitu. Cieľom našej práce bolo analyzovať realizáciu surveillance a definovať možnosti zlepšenia.
Metodika:
Retrospektívne sme analyzovali za sebou idúcich pacientov v intervale medzi januárom 2001 a decembrom 2010 so ŽIADÚCOU surveillance, kde sme si kládli tri otázky: 1. U koľkých bola surveillance ODPORÚČANÁ; 2. U koľkých bola VYKONANÁ a akou metódou; a 3. S akým výsledkom. Pacientov sme rozdelili do troch skupín – s dia­gnózou cirhózy, alebo HBV infekcie (ŽIADÚCA surveillance), s písomným odporúčaním surveillance (ODPORÚČANÁ), a s realizovanou surveillance (REALIZOVANÁ) pomocou ≥ 2 ultrasonografií (US), alebo AFP každých šesť mesiacov. Sledovali sme demografiu, charakteristiku ochorenia pečene, US, AFP, nové lézie, ich veľkosť a mortalitu. Vylúčení boli pacienti s nedostatkom údajov.
Výsledky:
Identifikovali sme 445 a vylúčili z nich 52 pacientov so ŽIADÚCOU surveillance. Zvyšných 393 pacientov tvorilo skupinu ODPORÚČANÁ, z toho 334 pacientov (85 %)  s cirhózou a 59 (15 %) s HBV infekciou. Medián veku bol 55 rokov, 34 % tvorili ženy. Najčastejšou etiológiou bola ALD (46 %), NASH (17 %), a HCV (12 %). Surveillance bola REALIZOVANÁ u 322 (82 %) pacientov zo skupiny ODPORÚČANÁ pomocou US u 1 %, AFP u 40 %, a US s AFP u 31 % pacientov. Nové lézie boli detekované u 2,2 % pacientov, s priemerným vekom 63,5 rokov (53 – 79), s priemerom 31,5 mm (9 – 120) u 8 pacientov v rámci surveillance a 75 mm (35 – 115) u 2 pacientov bez surveillance (p = 0,296).
Záver:
Táto štúdia kontroly kvality poukázala na suboptimálnu surveillance hepatocelulárneho karcinómu u pacientov v odporúčaných indikáciách, využívané metódy sa značne odlišovali od platných odporúčaní a priemer novozistených lézií bol väčší, ako by si vyžadovala efektívna surveillance.

Klíčová slova

surveillance, abdominal ultrasound, hepatocelulární karcinom, alpha-fetoprotein

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Literatura

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