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Updated Algorithm Shows Advantage in Predicting HCC
Researchers have found that an updated version of the Hepatocellular carcinoma (HCC) Early detection Screening (HES) algorithm offers an advantage over the serum alpha-fetoprotein (AFP) test in predicting patients most likely to develop HCC among those at risk.
“The HES algorithm incorporates data on age, level of alanine aminotransferase, platelet count, and rate of AFP change to increase likelihood of earlier detection and thereby reduce HCC-related mortality,” the authors wrote. “We updated the HES algorithm to include etiology of cirrhosis and validated it in a community-based cohort.”
The investigators used data on etiologies for HCC, including hepatitis C, hepatitis B, alcoholic liver disease, and nonalcoholic fatty liver disease, gathered from the Veterans Health Administration from the years 2010 through 2015. After updating the HES algorithm with these data, the team then tested its accuracy within a validation cohort of patients within the Kaiser Permanente Northern California health care system who had been diagnosed with cirrhosis. The validation cohort included 7432 patients with cirrhosis, of whom 1102 were diagnosed with HCC within a median follow-up period of 3.21 years; 709 patients of these patients had early-stage HCC.
“The HES algorithm identified patients who would receive a diagnosis of early-stage HCC within the next 6 months with 51.20% sensitivity and 90.00% specificity, compared with 46.02% sensitivity for the AFP test alone (5.18% absolute improvement; P = .0015),” the authors reported. “The number of early-stage HCC cases detected per 1000 imaging analyses were 136.46 with the HES algorithm vs 118.01 with the AFP test alone (P < .0005).”
The updated algorithm identified 56.00% of patients with HCC in the 6 months before their diagnosis, even when no nodules were detected by ultrasound, the researchers noted. The AFP test detected 50% of these patients.
“We validated the HES algorithm using data from a diverse community-based cohort of patients with cirrhosis. The algorithm offers a modest but useful advantage over the AFP test alone in detection of early-stage HCC with virtually no added cost,” the authors concluded.
--Rebecca Mashaw
Reference:
Tayob N, Corley DA, Christie I, et al. Validation of the updated hepatocellular carcinoma early detection screening algorithm in a community-based cohort of patients with cirrhosis of multiple etiologies. Clin Gastroenterol Hepatol. 2021;19(7): 1443-1450
