Gastroenterologie
a hepatologie

Surveillance hepatocelulárneho karcinómu na Slovensku

Svetlana Adamcová-Selčanová¹, Ľubomír Skladaný ^{Orcid.org  1}, Jana Čiefová¹, Sylvia Dražilová², Tomáš Koller ^{Orcid.org  3}, Peter Jarčuška ^{Orcid.org  4,5}, Miroslav Žigrai⁵

+ Pracoviště
¹ HEGITO (Division of Hepatology, Gastroenterology and Liver Transplantation), Department of Internal Medicine II, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic
² Oddelenie vnútorného lekárstva s JIS metabolickou, Nemocnica Poprad, a. s., Slovenská republika
³ Gastroenterologické a hepatologické oddelenie, V. interná klinika LF UK a UN Bratislava
⁴ I. interná klinika LF UPJŠ a UN L. Pasteura Košice, Slovenská republika
⁵ The working party of the Slovak Society of Hepatology

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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