Development and Internal Validation of a Model for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis.

Patel J, Yopp A, Waljee AK, Singal AG. Development and Internal Validation of a Model for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis. Journal of clinical gastroenterology. 2016 Feb 1; 50(2):175-9.

Related HSR&D Project(s)

• CDA 11-217 – Risk Stratification and Targeted Therapy for HELP Diseases in Veterans
• IIR 16-024 – Advanced Prediction Models to Optimize Treatment and Access for Veterans with Hepatitis C

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Abstract:

BACKGROUND: Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis; however, early detection efforts are limited by suboptimal effectiveness. AIM: To derive and validate a model to accurately distinguish cirrhotic patients with and without HCC and compare the accuracy of the model to that of a-fetoprotein (AFP) alone. METHODS: We conducted a case-control study of cirrhotic patients with and without HCC seen at a large urban hospital system between January 2005 and June 2012. We derived multivariate logistic regression models for the presence of HCC and early-stage HCC. Discriminatory power was evaluated using receiver operating characteristic curve analysis in derivation and validation cohorts using a 10-fold cross-validation approach. RESULTS: We identified 1356 patients with cirrhosis, with (n = 455, 147 early stage) and without (n = 901) HCC. We found that AFP > 20 ng/mL and FIB-4, a noninvasive marker of fibrosis, were significantly associated with the presence of HCC (OR = 10.5; 95% CI, 7.9-13.9 and OR = 1.05; 95% CI, 1.03-1.07, respectively) and early-stage HCC (OR = 4.4; 95% CI, 2.9-6.5 and OR = 1.06; 95% CI, 1.03-1.09, respectively). Models incorporating AFP and FIB-4 had good discriminatory power, with c-statistics of approximately 0.80, in both derivation and validation cohorts. The model for early-stage HCC had higher discriminatory power than AFP alone (c-statistic 0.73; 95% CI, 0.69-0.78) in derivation and validation cohorts (P = 0.02 and 0.15, respectively). CONCLUSIONS: Models including AFP and FIB-4 can accurately discriminate cirrhotic patients with early-stage HCC from those without HCC.