Öz
Aim: Hepatocellular carcinoma HCC is a significant cause of mortality in patients with chronic liver disease. The aim of this study was to analyze cost and the effectiveness of HCC screening in cirrhotic patients using abdominal computer tomography CT yearly in addition to ultrasonographic USG examination of the liver and serum alpha-feto protein AFP assay every 6 months. Patients and Methods: A total of 39 patients were followed-up for two years by screening with USG evaluation and AFP assay every 6 months and with contrast-enhanced abdominal CT yearly. Results: The patients comprised 22 men and 17 women mean age: 62 ± 10 years . Fifteen patients had hepatitis B virus, 9 had hepatitis C virus, 4 had both hepatitis B and C viruses, 3 had hepatitis B virus and ethanol abuse, 1 had hepatitis C and ethanol abuse and 7 had cryptogenic cirrhosis. The mean duration of cirrhosis was 3.4 ± 2.7 years. The diagnosis of liver cirrhosis was made on clinical, biochemical, USG and endoscopic findings. In a total of 39 patients, 5 of them had suspected hepatic lesion with a size of 1.2–5 cm upon examination with abdominal CT. Only one patient was diagnosed with cholangiocarcinoma but not with HCC with additional examination with CT arteriography and was underwent resection. No lesion was determined in other 4 patients examined additionally with abdominal MRI or abdominal CT arteriography. The cost of USG examination and serum AFP assay of one patient every 6 months was approximately 150 TL. The total yearly cost of USG + serum AFP of 39 patients was 11700 TL. The total yearly cost of abdominal CT of 39 patients was 9009 TL. Considering 5 patients with suspected lesions, the total cost of additional examinations was 1947 TL. Conclusion: Additional screening with CT did not improve the early detection of HCC but increased the yearly cost in cirrhotic patients.
Anahtar Kelimeler
Kaynakça
- Bialecki ES, Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005;7(1):26-34.
- Collier J, Sherman M. Screening for hepatocellular carcinoma. Hepatology. 1998 Jan;27(1):273-8.
- Sarasin FP, Giostra E, Hadengue A. Cost-effectiveness of screening for detection of small hepatocellular carcinoma in western patients with Child- Pugh class A cirrhosis. Am J Med 1996; 101: 422-34.
- Bolondi L, Sofia S, Siringo S, Gaiani S, Casali A, Zironi G, et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut 2001; 48: 251-9.
- Meissner HI, Smith RA, Rimer BK, et al. Promoting cancer screening: learning from experience. Cancer 2004:; 101: 1107-17.
- Chalasani N, Said A, Ness R, et al. Screening for hepatocellular caircinoma in patients with cirrhosis in the United States: results of a national survey. Am J Gastroenterol 1999; 94(8); 2224-9.
- Kinsky GA, Lee VS, Thiese ND, et al. Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explant correlation. Radiology 2001; 219: 445-54.
- Rode A, Bancel B, Douek P, et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 2001; 25: 327-36.
- Burrel M, Llovet JM, Ayuso C, et al. MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 2003; 38: 1034-42.
Öz
Amaç: Hepatoselüler kanser HSK kronik karaciğer hastalarında önemli mortalite nedenidir. Bu çalışmanın amacı sirotik hastalarda HSK taraması yapılırken 6 aylık alfa-feto protein AFP ve ultrasonografi USG ’ye ek olarak yıllık bilgisayarlı tomografi BT takibinin etkisini ve maliyet analizini araştırmaktır. Hastalar ve Yöntem: İki yıl boyunca toplam 39 sirotik hasta 6 aylık USG ve AFP ölçümüne ek olarak yıllık abdominal BT ile izlendi. Bulgular: Hastaların 22’si erkek, 17’si kadındı ortalama yaş: 62 ± 10 . Onbeş hasta hepatit B ile, 9 hasta hepatit C ile, 4 hasta hem hepatit B hem de C ile infekteydi. Ayrıca 3’ü hepatit B virusu ile infekte ve alkol kötüye kullanımı vardı. Yine bir hasta hem hepatit C ile infekteydi, hem de alkol kötüye kullanımı vardı. Yedi hasta kriptojenik siroz nedeniyle takipteydi. Hastaların siroz tanısı ile takip süreleri ortalama 3.4 ± 2.7 yıldı. Bu tanılar klinik, biyokimyasal, ultrasonografik ve endoskopik bulgularla koyuldu. Takip sırasında 39 hastanın beşinde BT’de 1,2 ile 5 cm arasında değişen karaciğer kitleleri saptandı. Bu beş kitleden sadece biri ek incelemeler sonrası rezeksiyon gerektiren malignite çıktı. Bu da HSK değil kolanjiokarsinomaydı. Diğer dört hastada ise ek olarak yapılan abdominal magnetik rezonans görüntüleme MRG veya BT arteriografiye rağmen herhangi bir lezyon saptanmadı. Bir hastanın altı ayda bir yapılan AFP+USG incelemesinin maliyeti 150 TL, yıllık 39 hastanın maliyeti ise 11700 TL idi. Otuz dokuz hastanın yıllık abdominal BT bedeli ise 9009 TL idi. Beş hastaya yapılan ek incelemelere baktığımızda ek incelemelerin maliyeti ise 1947 TL idi. Sonuç: BT ile yapılan ek inceleme HSK’nin erken saptanmasını sağlamadığı gibi sirotik hastaların yıllık takip maliyetini arttırmaktadır.
Anahtar Kelimeler
Kaynakça
- Bialecki ES, Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005;7(1):26-34.
- Collier J, Sherman M. Screening for hepatocellular carcinoma. Hepatology. 1998 Jan;27(1):273-8.
- Sarasin FP, Giostra E, Hadengue A. Cost-effectiveness of screening for detection of small hepatocellular carcinoma in western patients with Child- Pugh class A cirrhosis. Am J Med 1996; 101: 422-34.
- Bolondi L, Sofia S, Siringo S, Gaiani S, Casali A, Zironi G, et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut 2001; 48: 251-9.
- Meissner HI, Smith RA, Rimer BK, et al. Promoting cancer screening: learning from experience. Cancer 2004:; 101: 1107-17.
- Chalasani N, Said A, Ness R, et al. Screening for hepatocellular caircinoma in patients with cirrhosis in the United States: results of a national survey. Am J Gastroenterol 1999; 94(8); 2224-9.
- Kinsky GA, Lee VS, Thiese ND, et al. Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explant correlation. Radiology 2001; 219: 445-54.
- Rode A, Bancel B, Douek P, et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 2001; 25: 327-36.
- Burrel M, Llovet JM, Ayuso C, et al. MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 2003; 38: 1034-42.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2011 |
| Yayımlandığı Sayı | Yıl 2011Sayı: 4 |