Table CDR62840 Liver Cancer Screening/肝癌筛查
ID Type Description_en Description_zh
w1 Word Alpha-fetoprotein 甲胎蛋白
w2 Word Hepatic Ultrasound 肝脏超声
w3 Word Computed Tomography 计算机断层扫描
p1 Phrase Hepatitis C virus 丙型肝炎病毒
p2 Phrase Rationale for Screening 筛查的合理性
p3 Phrase Dominant Geographical Area 主要地理区域
p4 Phrase Hepatitis B virus 乙型肝炎病毒
p5 Phrase Evidence of Harms 伤害证据
p6 Phrase Likely Etiology of HCC 肝细胞癌的可能病因
p7 Phrase Liver (Hepatocellular) Cancer Screening 肝癌（肝细胞癌）筛查
p8 Phrase Study Design: Randomized controlled trials 研究设计：随机对照临床试验
p9 Phrase The CI was near 1.0 CI接近1.0
p10 Phrase Incidence, Mortality, and Risk Factors 发病率、死亡率与危险因素
p11 Phrase Intention-to-treat analysis was not used 未使用意向治疗分析
p12 Phrase Liver (Hepatocellular) Cancer (PDQ®): Screening 肝癌（肝细胞癌）（PDQ®）：筛查
p13 Phrase Assessment of outcome was not blinded 结果评估未设盲
p14 Phrase The results varied in different publications 不同文献报道的结果不同
p15 Phrase Efficacy of Screening and Surveillance Programs 筛查与监测项目的有效性
p16 Phrase Generalizability to other populations is uncertain 结果对其他人群的适用性并不确定
p17 Phrase Consistency: Multiple studies, large number of participants 一致性：多项研究，参与者人数较多
p18 Phrase The comparison group was not actively followed 对照组无积极随访
p19 Phrase The PPVs were 14% and 73%, respectively PPV分别为14%和73%
s1 Sentence Tumor Markers for the Detection of Hepatocellular Carcinoma 检测肝细胞癌的肿瘤标记物
s2 Sentence Whether screening actually improved survival is not clear 筛查是否改善生存率目前尚不明确
s3 Sentence Study Design: Randomized controlled trials and observational studies 研究设计：随机对照临床试验与观察性研究
s4 Sentence All patients were followed up for liver cancer and/or death 对所有患者随访至发生肝癌和（或）死亡
s5 Sentence Two kinds of harms or complications may result from screening 筛查可能带来两类伤害或并发症
s6 Sentence Abnormal screening results may lead to liver biopsy for diagnosis 若结果存在异常，则行肝活检以进一步诊断
s7 Sentence Complications include hemorrhage, bile peritonitis, penetration of viscera, and pneumothorax 并发症包括出血、胆汁性腹膜炎、脏器穿孔和气胸
s8 Sentence While these results are promising, there were problems, including the following: 结果看似前景良好，但是也伴随着一定的问题，包括：
s9 Sentence The likely etiology of HCC is summarized in the following table HCC可能的病因总结见下表
s10 Sentence Rarely, death occurs as a direct result of liver biopsy (0.009%–0.12%) 肝活检直接导致死亡的案例非常罕见（0.009%-0.12%）
s11 Sentence Hepatocellular cancer (HCC) is the fourth most common cancer in the world 肝细胞癌（HCC）是全球第四大常见癌症
s12 Sentence The modalities potentially available for screening include serum alpha-fetoprotein (AFP) and ultrasonography 目前可用的筛查方法包括甲胎蛋白（AFP）和超声
s13 Sentence These include oncofetal antigens and glycoprotein antigens; enzymes and isoenzymes; genes; and cytokines 包括癌胚抗原和糖蛋白抗原类、酶和同工酶类、基因类和细胞因子类
s14 Sentence The overall sensitivity and specificity of the program were 55.3% and 86.5%, respectively 该项目的总体敏感性和特异性分别为55.3%和86.5%
s15 Sentence However, 20% to 50% of patients presenting with HCC have previously undiagnosed cirrhosis 然而20%-50%的HCC患者的肝硬化在此前并未被诊断
s16 Sentence Sensitivity in the former was 71% and in the latter 78%, with 93% specificity 对于健康的乙肝表面抗原携带者，超声的敏感性为71%，肝硬化患者中敏感性则为78%，特异性为93%
s17 Sentence Expert-reviewed information summary about tests used to detect or screen for liver (hepatocellular) cancer 关于肝癌（肝细胞癌）检测或筛查的专家审核信息
s18 Sentence Cirrhosis is also a risk factor for HCC, irrespective of the etiology of the cirrhosis 各种病因引起的肝硬化均是HCC的危险因素
s19 Sentence The annual risk of developing HCC among persons with cirrhosis is between 1% and 6% 肝硬化患者HCC的年发生率为1%至6%
s20 Sentence Needle aspiration cytology and liver biopsy are rarely associated with needle-track implantation of malignant cells 细针抽吸细胞学和肝活检很少导致恶性细胞的针道种植
s21 Sentence Direct harms may result from complications of liver biopsy done as part of the diagnostic workup 肝活检作为诊断的常用手段可以带来直接伤害
s22 Sentence Screening entailed 6-monthly AFP assays, with follow-up of patients having an abnormal (≥20 μg/L) test result 筛查组每6个月进行一次AFP检测，对结果异常（≥20μg/L）的患者进行随访
s23 Sentence In patients who complied with all scheduled screening tests, sensitivity was 80% and specificity was 80.9% 在所有遵循全筛查流程的患者中的敏感性为80%，特异性为80.9%
s24 Sentence The incidence of HCC in individuals with chronic hepatitis is as high as 0.46% per year 慢性肝炎患者中，HCC年发病率高达0.46%
s25 Sentence This association, however, is blurred by the frequent coexistence of hepatitis B infection in those population groups 但这一相关性并不明确，因为当地人群乙肝病毒共感染率亦高
s26 Sentence In the United States, chronic hepatitis B and C account for about 30% to 40% of HCC 在美国，30%-40%的HCC由慢性乙型肝炎与丙型肝炎引起
s27 Sentence Age-standardized incidence rates vary from 2.1 per 100,000 in North America to 80 per 100,000 in China 北美的年龄标准化发病率为每年每十万人2.1例，在中国这一数据则为每年每十万人80例
s28 Sentence Chronic hepatitis G infection is not associated with HCC in either hepatitis B surface antigen–positive carriers or noncarriers 无论对于乙肝病毒表面抗原阳性的携带者或非携带者，慢性庚型肝炎的感染与HCC的发病无关
s29 Sentence Serum AFP, a fetal-specific glycoprotein antigen, is the most widely used tumor marker for detecting patients with HCC 血清AFP是一种胚胎特异性糖蛋白抗原，是检测HCC最广泛使用的肿瘤标记物
s30 Sentence Transjugular liver biopsy is rarely associated with major complications such as perforation of the hepatic capsule or cholangitis 经颈静脉肝活检罕见的并发症主要为，诸如肝包膜穿孔或胆管炎
s31 Sentence Such high sensitivity and specificity have not been found for other high-risk groups, such as individuals with cirrhosis 但在其他高危人群（如肝硬化患者）中并未观察到类似的高敏感性和特异性
s32 Sentence Aflatoxins, which are mycotoxins formed by certain Aspergillus species, are a frequent contaminant of improperly stored grains and nuts 由某些黄曲霉菌产生的真菌毒素黄曲霉素常污染储存不当的谷物和坚果
s33 Sentence There are four categories of tumor markers that are currently being used or studied for the detection of hepatocellular carcinoma 目前有四类肿瘤标记物被用于肝细胞癌的检测或研究
s34 Sentence Based on fair evidence, screening of persons at elevated risk does not result in a decrease in mortality from hepatocellular cancer 充分的证据表明，对高危人群的筛查并不能帮助降低肝细胞癌的死亡率
s35 Sentence Such complications are reported in 0.06% to 0.32% of patients, and typically occur within the first few hours after the biopsy 据报道，约有0.06%-0.32%的患者发生并发症，通常出现于进行活检后的数小时内
s36 Sentence In parts of Africa, the high incidence of HCC in humans may by related to ingestion of foods contaminated with aflatoxins 在非洲的某些地区，人群中HCC的高发可能和摄入此类被污染食物有关
s37 Sentence The screening program’s target was AFP determination every 6 months. It achieved 97% sensitivity and 95% specificity (excluding pregnant women) for HCC 这一筛查项每6个月检测一次AFP水平，其对HCC的敏感性和特异性分别高达97%和95%（妊娠妇女除外）
s38 Sentence These patients would not be recruited into a surveillance program if the presence of cirrhosis is used to define a target population 如果用肝硬化作为标准寻找目标人群，则此类患者将不被纳入监测项目
s39 Sentence About one third of patients experience pain at the site of entry, in the right upper quadrant, or in the right shoulder 约有三分之一的患者有穿刺处疼痛，位于右上腹或放射至右肩
s40 Sentence HCC mortality was lower in the screened group (83.2 vs. 131.5 per 100,000; mortality rate ratio of 0.63 [95% confidence interval (CI), 0.41–0.98]) 筛查组的HCC死亡率较低（分别为每十万人83.2例和131.5例；死亡率比为0.63[95%置信区间（CI），0.41-0.98]）
s41 Sentence Other risk factors include alcoholic cirrhosis, hemochromatosis, alpha-l-antitrypsin deficiency, glycogen storage disease, porphyria cutanea tarda, tyrosinemia, and Wilson disease, but rarely biliary cirrhosis 其他危险因素包括酒精性肝硬化、血色素沉着症、α-1抗胰蛋白酶缺乏症、糖原贮积病、迟发型皮肤卟啉病、酪氨酸血症和Wilson氏病，但胆汁性肝硬化极少引起HCC
s42 Sentence Complications of liver biopsy are reported in 0.06% to 0.32% of patients, and typically occur within the first few hours after the biopsy 据报道，约有0.06%-0.32%的患者出现肝活检并发症，主要出现于进行活检后的数小时内
s43 Sentence Studies in patients with cirrhosis suggest that CT may be a more sensitive test for HCC than ultrasound or AFP more than 20 μg/L 在肝硬化患者中进行的研究显示CT对HCC的敏感性可能优于超声和AFP大于20μg/L的筛查
s44 Sentence AFP is not specific for HCC. Titers also rise in acute or chronic hepatitis, in pregnancy, and in the presence of germ cell tumors AFP并不是HCC特异性标记物，有急性或慢性肝炎、妊娠和生殖细胞瘤的情况下均可见AFP升高
s45 Sentence In the United States, it is estimated that there will be 30,640 new cases diagnosed in 2013 and 21,670 deaths due to this disease 据估计，2013年美国将新诊断30,640例肝细胞癌，并且有21,670例死亡发生
s46 Sentence A review concluded that the method of measuring AFP was not sensitive enough to detect HCC, affecting interpretation of the negative result of this trial 一项综述得出结论，测量AFP对于检测HCC的敏感性不足，使对本试验阴性结果的解读有一定的困难
s47 Sentence Added text about a review that concluded the method of measuring alpha-fetoprotein was not sensitive enough to detect hepatocellular carcinoma, affecting the interpretation of negative results 增添文本，介绍一篇综述中总结道测量甲胎蛋白的方法敏感性不足以检测肝细胞癌，可能影响阴性结果的解读
s48 Sentence Limitations in the sensitivity and specificity of AFP in surveillance of high-risk populations led to the use of ultrasound as an additional method for detection of HCC 因AFP对于监测高危人群的敏感性和特异性有限，肝脏超声被认为是筛查HCC的另一种方法
s49 Sentence Studies in both healthy hepatitis B surface antigen carriers and in patients with cirrhosis have defined the performance characteristics of ultrasound as a screening test for HCC 在健康的乙肝表面抗原携带者和肝硬化患者中进行的研究报告了肝脏超声用于筛查HCC的一系列声像图特点
s50 Sentence The rationale for screening for hepatocellular carcinoma (HCC) is based on the concept that populations at high risk for HCC, such as those with cirrhosis, can be identified 对肝细胞癌（HCC）进行筛查的原因是基于HCC高危人群如肝硬化患者可被识别
s51 Sentence The reported sensitivity of AFP for detecting HCC varies widely in both hepatitis B virus (HBV)-positive and HBV-negative populations, which is attributable to overlap between screening and diagnosis study designs 在乙型肝炎病毒（HBV）阳性或阴性的人群中，研究报告AFP检测HCC的敏感性各异，主要原因是筛查与诊断研究设计之间有一定的交叉性
s52 Sentence When AFP is used for screening of high-risk populations, a sensitivity of 39% to 97%, specificity of 76% to 95%, and a positive predictive value (PPV) of 9% to 32% have been reported 用AFP作为标记筛查高危人群时其敏感性为39%-97%，特异性为76%-95%，阳性预测值（PPV）为9%-32%
s53 Sentence Chronic hepatitis B and C are recognized as the major factors worldwide increasing the risk of HCC, with risk being greater in the presence of coinfection with hepatitis B virus and hepatitis C virus 慢性乙型肝炎和丙型肝炎在全球被广泛认为是HCC的主要危险因素，存在乙型肝炎病毒与丙型肝炎病毒共同感染时风险更甚
s54 Sentence A controlled trial of 18,816 persons aged 35 to 59 years with hepatitis B in Shanghai randomly assigned patients to a screening group using AFP and ultrasound every 6 months versus a usual-care group 上海一项对18,816例35-59岁乙肝感染者进行的对照研究将患者随机分组，分别接受AFP加超声筛查（每6个月进行一次）或常规组
s55 Sentence A prospective, 16-year, population-based, observational study of screening for hepatocellular cancer among 1,487 Alaska Natives chronically infected with HBV compared survival among screen-detected HCC patients with a historical comparison group of clinically diagnosed HCC patients 一项持续16年、基于人群的前瞻性观察研究对1487例有慢性HBV感染的阿拉斯加居民进行了肝细胞癌筛查，并对筛查发现的HCC人群和此前经临床诊断的HCC患者对照组进行了比较
s56 Sentence Limitations in the sensitivity and specificity of AFP and ultrasound in surveillance of high-risk populations, such as individuals with cirrhosis, led to the assessment of computed tomography (CT) as an additional method for detection of HCC 由于AFP与肝脏超声对于高危人群（诸如肝硬化患者）筛查的敏感性和特异性存在局限性，故借助计算机断层扫描（CT）作为检测HCC的另一种方法
s57 Sentence Based on fair evidence, screening would result in rare but serious side effects associated with needle aspiration cytology such as needle-track seeding, particularly of lesions more than 2 cm in diameter, and hemorrhage, bile peritonitis, and pneumothorax 充分的证据表明，细针抽吸细胞学筛查法可导致罕见但严重的副作用，例如针道种植（尤见于直径2厘米以上的病灶）、出血、胆汁性腹膜炎和气胸
s58 Sentence In a study of patients who were on a waiting list for liver transplantation, ultrasonography was found to have a sensitivity of 58%, a specificity of 94%, a negative predictive value of 91%, and a PPV of 68% 一项在等待肝移植的患者中进行的研究显示，肝脏超声的敏感性为58%，特异性为94%，阴性预测值为91%，PPV为68%
s59 Sentence A retrospective case-control study found that features suggestive of nonalcoholic steatohepatitis, including obesity, type 2 diabetes, dyslipidemia, and insulin resistance, were more frequently observed in patients with HCC associated with cryptogenic cirrhosis than in those with HCC of viral or alcohol etiology 一项回顾性病例对照研究对比了隐匿性肝硬化相关HCC患者和病毒、酒精引起的HCC患者，发现非酒精性脂肪肝的危险因素如肥胖、II型糖尿病、血脂异常、胰岛素抵抗更常见于隐匿性肝硬化相关HCC患者
s60 Sentence A randomized controlled trial studied 5,581 men aged 30 to 69 years who were chronic carriers of HBV between 1989 and 1995 in Qidong County, China. Of these men, 3,712 were randomly assigned to a screening group and 1,869 to a control group 1989年至1995年对中国启东市的5,581例年龄在30-69岁之间的慢性HBV携带者进行了一项随机对照试验，其中筛查组3,712例，对照组1,869例
s61 Sentence There is a distinct male preponderance among all ethnic groups in the United States, although this trend is most marked among Chinese Americans, in whom the annualized rate of HCC among men is 22.1 per 100,000 and among women is 8.5 per 100,000 population 美国不同种族的人群中均为男性高发，而在华裔美国人中这种趋势最显著。华裔美国人中，男性HCC年发病率为每十万人22.1例，女性HCC年发病率为每十万人8.5例
s62 Sentence The mortality rate in the screening group (1,138 per 100,000 person-years) was not significantly different from that in the control group (1,114 per 100,000 person-years), although AFP screening resulted in an earlier diagnosis of liver cancer (i.e., percentage of cases in stage I was significantly higher in the screened group [29.0%] than in the control group [6%]) 筛查组的死亡率（每十万人年1,138例）与对照组（ 每十万人年1,114例）对比无显著差异，但AFP筛查可以较早诊断肝癌（即筛查组中被诊断为I期肝癌的病例所占的比例[29.0%]高于对照组[6%]）
s63 Sentence Lead-time bias (earlier diagnosis in the natural history of HCC rather than improved survival from earlier diagnosis and treatment), length bias (earlier detection of slower-growing and less aggressive tumors through screening), and/or overdiagnosis of HCC (detection of tumors that will not affect morbidity or mortality) may wholly or partially account for the improved 5-year and 10-year survival rates reported 尽管研究报告筛查后的5年和10年生存率有所改善，但领先时间偏倚（在HCC自然病程中被早期诊断，而非通过早期诊断与治疗提高生存率）、病程长短偏倚（对进展缓慢、侵袭性低的肿瘤的早期发现）和（或）对HCC的过度诊断（对不影响发病率和死亡率的肿瘤的探查）可能是产生此结果的全部或部分原因
s64 Sentence Revised text to state that while these results are promising, there were problems, including the following: the results varied in different publications; the comparison group was not actively followed; the confidence interval was near 1.0; intention-to-treat analysis was not used; assessment of outcome was not blinded; and generalizability to other populations is uncertain (cited Aghoram et al. as reference 14) 修订内容，说明尽管这些结果具有良好前景，但仍存在下列问题：不同人群中结果各异；未对比较组进行积极随访；置信区间接近1.0；未使用意向治疗分析；未对结局评估设盲；不确定是否可适用于其他人群（引用Aghoram等人的研究，见参考文献14）