PDF(Pubmed)
Abstract：
UNASSIGNED: The incidence and mortality of hepatocellular carcinoma (HCC) have been increasing around the world. Current guidelines recommend HCC screening in high-risk population. However, the strength of evidence of benefits and harms of HCC screening to support the recommendation was unclear. The objective is to systematically synthesize current evidence on the benefits and harms of HCC screening.
UNASSIGNED: We searched PubMed and nine other databases until August 20, 2021. We included cohort studies and RCTs that compared the benefits and harms of screening and non-screening in high-risk population of HCC. Case series studies that reported harms of HCC screening were also included. Pooled risk ratio (RR), according to HCC screening status, was calculated for each benefit outcome (e.g., HCC mortality, survival rate, proportion of early HCC), using head-to-head meta-analysis. The harmful outcomes (e.g., proportion of physiological harms provided by non-comparative studies were pooled by prevalence of meta-analysis. Analysis on publication bias and quality of life, subgroup analysis, and sensitivity analysis were also conducted.
UNASSIGNED: We included 70 studies, including four random clinical trials (RCTs), 63 cohort studies,three case series studies. The meta-analysis of RCTs showed HCC screening was significantly associated with reduced HCC mortality (RR [risk ratio], 0.73 [95% CI, 0.56-0.96]; I 2 = 75.1%), prolonged overall survival rates (1-year, RR, 1.72 [95% CI, 1.13-2.61]; I 2 = 72.5%; 3-year, RR, 2.86 [95% CI, 1.78-4.58]; I 2 = 10.1%; and 5-year, RR, 2.76 [95% CI, 1.37-5.54]; I 2 = 28.3%), increased proportion of early HCC detection (RR, 2.68 [95% CI, 1.77-4.06]; I 2 = 50.4%). Similarly, meta-analysis of cohort studies indicated HCC screening was more effective than non-screening. However, pooled proportion of physiological harms was 16.30% (95% CI: 8.92%-23.67%) and most harms were of a mild to moderate severity.
UNASSIGNED: The existing evidence suggests HCC screening is more effective than non-screening in high-risk population. However, harms of screening should not be ignored.
UNASSIGNED: We searched PubMed and nine other databases until August 20, 2021. We included cohort studies and RCTs that compared the benefits and harms of screening and non-screening in high-risk population of HCC. Case series studies that reported harms of HCC screening were also included. Pooled risk ratio (RR), according to HCC screening status, was calculated for each benefit outcome (e.g., HCC mortality, survival rate, proportion of early HCC), using head-to-head meta-analysis. The harmful outcomes (e.g., proportion of physiological harms provided by non-comparative studies were pooled by prevalence of meta-analysis. Analysis on publication bias and quality of life, subgroup analysis, and sensitivity analysis were also conducted.
UNASSIGNED: We included 70 studies, including four random clinical trials (RCTs), 63 cohort studies,three case series studies. The meta-analysis of RCTs showed HCC screening was significantly associated with reduced HCC mortality (RR [risk ratio], 0.73 [95% CI, 0.56-0.96]; I 2 = 75.1%), prolonged overall survival rates (1-year, RR, 1.72 [95% CI, 1.13-2.61]; I 2 = 72.5%; 3-year, RR, 2.86 [95% CI, 1.78-4.58]; I 2 = 10.1%; and 5-year, RR, 2.76 [95% CI, 1.37-5.54]; I 2 = 28.3%), increased proportion of early HCC detection (RR, 2.68 [95% CI, 1.77-4.06]; I 2 = 50.4%). Similarly, meta-analysis of cohort studies indicated HCC screening was more effective than non-screening. However, pooled proportion of physiological harms was 16.30% (95% CI: 8.92%-23.67%) and most harms were of a mild to moderate severity.
UNASSIGNED: The existing evidence suggests HCC screening is more effective than non-screening in high-risk population. However, harms of screening should not be ignored.
摘要：
■肝细胞癌（HCC）的发病率和死亡率在世界范围内一直在增加。目前的指南建议在高危人群中进行HCC筛查。然而,支持该建议的HCC筛查的利弊证据尚不清楚.目的是系统地综合目前关于HCC筛查的利弊的证据。
■我们搜索了PubMed和其他9个数据库，直到2021年8月20日。我们纳入了队列研究和RCTs，比较了HCC高危人群中筛查和非筛查的益处和危害。还包括报告HCC筛查危害的病例系列研究。集合风险比(RR)，根据肝癌筛查状态，为每个福利结果计算(例如，HCC死亡率，存活率,早期肝癌的比例)，使用头对头荟萃分析。有害结果(例如，非比较研究提供的生理危害比例通过荟萃分析的患病率汇总.发表偏倚和生活质量分析，亚组分析，并进行了敏感性分析。
■我们纳入了70项研究，包括四项随机临床试验(RCT)，63项队列研究，三个案例系列研究。RCT的荟萃分析显示，HCC筛查与降低HCC死亡率显着相关（RR[风险比]，0.73[95%CI，0.56-0.96]；I2=75.1%），延长总生存率(1年，RR,1.72[95%CI，1.13-2.61]；I2=72.5%；3年，RR,2.86[95%CI，1.78-4.58]；I2=10.1%；5年期，RR,2.76[95%CI，1.37-5.54]；I2=28.3%），早期肝癌检测比例增加(RR，2.68[95%CI，1.77-4.06]；I2=50.4%）。同样，队列研究的荟萃分析表明，肝癌筛查比非筛查更有效。然而,生理损害的合并比例为16.30%(95%CI:8.92%-23.67%),大多数损害为轻度至中度严重程度.
■现有证据表明，在高危人群中，肝癌筛查比非筛查更有效。然而,筛查的危害不容忽视。
■我们搜索了PubMed和其他9个数据库，直到2021年8月20日。我们纳入了队列研究和RCTs，比较了HCC高危人群中筛查和非筛查的益处和危害。还包括报告HCC筛查危害的病例系列研究。集合风险比(RR)，根据肝癌筛查状态，为每个福利结果计算(例如，HCC死亡率，存活率,早期肝癌的比例)，使用头对头荟萃分析。有害结果(例如，非比较研究提供的生理危害比例通过荟萃分析的患病率汇总.发表偏倚和生活质量分析，亚组分析，并进行了敏感性分析。
■我们纳入了70项研究，包括四项随机临床试验(RCT)，63项队列研究，三个案例系列研究。RCT的荟萃分析显示，HCC筛查与降低HCC死亡率显着相关（RR[风险比]，0.73[95%CI，0.56-0.96]；I2=75.1%），延长总生存率(1年，RR,1.72[95%CI，1.13-2.61]；I2=72.5%；3年，RR,2.86[95%CI，1.78-4.58]；I2=10.1%；5年期，RR,2.76[95%CI，1.37-5.54]；I2=28.3%），早期肝癌检测比例增加(RR，2.68[95%CI，1.77-4.06]；I2=50.4%）。同样，队列研究的荟萃分析表明，肝癌筛查比非筛查更有效。然而,生理损害的合并比例为16.30%(95%CI:8.92%-23.67%),大多数损害为轻度至中度严重程度.
■现有证据表明，在高危人群中，肝癌筛查比非筛查更有效。然而,筛查的危害不容忽视。
