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Clin Gastroenterol Hepatol. 2018 Dec 14. pii: S1542-3565(18)31378-8. doi: 10.1016/j.cgh.2018.12.005. [Epub ahead of print]

Validation of the Hepatocellular Carcinoma Early detection Screening (HES) algorithm in a Cohort of Veterans with Cirrhosis.

Author information

1
Department of Biostatistics, The University of Texas MD Anderson Cancer Center Houston, TX.
2
Houston VA Health Services Research and Development Service Center of Excellence (Houston, TX), Section of Health Services Research, Michael E. DeBakey VA Medical Center (Houston, TX) and Baylor College of Medicine, Houston, TX.
3
Kaiser Permanente, Northern California, San Francisco Medical Center (San Francisco, CA) and Division of Research Oakland, CA.
4
Houston VA Health Services Research and Development Service Center of Excellence (Houston, TX), Section of Health Services Research, Michael E. DeBakey VA Medical Center (Houston, TX) and Baylor College of Medicine, Houston, TX. Electronic address: hasheme@bcm.edu.

Abstract

BACKGROUND & AIMS:

Early detection of hepatocellular carcinoma (HCC) through surveillance reduces mortality associated with this cancer. Guidelines recommend HCC surveillance every 6 months for patients with cirrhosis, via ultrasonography, with or without measurement of serum level of alpha fetoprotein (AFP).

METHODS:

We previously developed and internally validated an HCC early detection screening (HES) algorithm that included patient's current level of AFP, rate of AFP change, age, level of alanine aminotransferase, and platelet count in a department of Veterans affairs (VA) cohort with active hepatitis C virus-related cirrhosis. HES score was associated with 3.84% absolute improvement in sensitivity of detection of HCC compared with AFP alone, at 90% specificity, within 6 months prior to diagnosis of this cancer. We externally validated the HES algorithm in a cohort of 38,431 patients with cirrhosis of any etiology evaluated at a VA medical center from 2010 through 2015.

RESULTS:

A total of 4804 cases of HCC developed during a median follow-up time of 3.12 years. At 90% specificity, the HES algorithm identified patients with HCC with 52.56% sensitivity, compared to 48.13% sensitivity for the AFP assay alone, within 6 months prior to diagnosis; this was an absolute improvement of 4.43% (P<.0005). In HCC screening, a positive result leads to follow-up evaluation by computed tomography or magnetic resonance imaging. We estimated that the number of HCC cases detected per 1000 imaging analyses were 198.57 for the HES algorithm vs 185.52 for the AFP assay alone, or detection of 13 additional cases of HCC (P<.0005).

CONCLUSION:

We validated the HES algorithm in detection of HCC in patients with cirrhosis of any etiology evaluated at VA medical centers. The algorithm offers a modest but useful advantage over AFP alone in HCC surveillance.

KEYWORDS:

ALT; HCV; Longitudinal biomarkers; Predictive modeling

PMID:
30557738
DOI:
10.1016/j.cgh.2018.12.005

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