PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：肝细胞癌（HCC）提出了重大的全球健康挑战，特别是在肝硬化患者中，与丙型肝炎（HCV）的主要原因。在与HCV相关的肝硬化患者中，肝癌的风险增加后仍存在治愈。具有六个月超声的HCC监测已被证明可以提高生存率。然而,坚持一年两次的筛查目前是次优的。本研究旨在评估增加HCC监测摄取和改善超声敏感性对HCV治愈后HCV相关性肝硬化患者死亡率的影响。
方法：本研究利用数学模型评估HCC进展，监视,诊断,以及成功接受HCV治疗的肝硬化患者的治疗。确定性房室模型纳入了巴塞罗那临床肝癌（BCLC）阶段，以模拟100名肝硬化患者的疾病进展和诊断概率，这些患者已成功治疗了超过10年的丙型肝炎。对四种干预措施进行了建模，以评估其改善预期寿命的潜力：监测依从性的现实改善，对监测依从性的乐观改善，诊断灵敏度增强，结果:实际依从性改善导致10年干预期内每100个队列增加9.8(95%CI7.9,11.6)个生命年;乐观依从性改善达到17.2(13.9,20.3)个生命年.诊断灵敏度的提高导致生命年增加7.0（3.6，13.8）年，治疗改善使寿命年延长9.0(7.5,10.3)年。
结论：定期HCC超声监测对于降低治愈的丙型肝炎和肝硬化患者的死亡率仍然至关重要。我们的研究强调，即使是对超声监测依从性的微小增强，也可以比提高监测敏感性或治疗效果的策略更有效地显著提高人群的预期寿命。
方法：本研究利用数学模型评估HCC进展，监视,诊断,以及成功接受HCV治疗的肝硬化患者的治疗。确定性房室模型纳入了巴塞罗那临床肝癌（BCLC）阶段，以模拟100名肝硬化患者的疾病进展和诊断概率，这些患者已成功治疗了超过10年的丙型肝炎。对四种干预措施进行了建模，以评估其改善预期寿命的潜力：监测依从性的现实改善，对监测依从性的乐观改善，诊断灵敏度增强，结果:实际依从性改善导致10年干预期内每100个队列增加9.8(95%CI7.9,11.6)个生命年;乐观依从性改善达到17.2(13.9,20.3)个生命年.诊断灵敏度的提高导致生命年增加7.0（3.6，13.8）年，治疗改善使寿命年延长9.0(7.5,10.3)年。
结论：定期HCC超声监测对于降低治愈的丙型肝炎和肝硬化患者的死亡率仍然至关重要。我们的研究强调，即使是对超声监测依从性的微小增强，也可以比提高监测敏感性或治疗效果的策略更有效地显著提高人群的预期寿命。
