Development and internal validation of a model for early detection of hepatocellular carcinoma in patients with cirrhosis

Jaimin Patel, Adam Yopp, Akbar K. Waljee, Amit G. Singal

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)175-179
Number of pages5
JournalJournal of Clinical Gastroenterology
Volume50
Issue number2
DOIs
StatePublished - 2016

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Hepatocellular Carcinoma
Fibrosis
Fetal Proteins
Logistic Models
Urban Hospitals
ROC Curve
Case-Control Studies

Keywords

  • A-fetoprotein
  • Cirrhosis
  • FIB-4
  • Liver cancer
  • Risk factors

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Development and internal validation of a model for early detection of hepatocellular carcinoma in patients with cirrhosis. / Patel, Jaimin; Yopp, Adam; Waljee, Akbar K.; Singal, Amit G.

In: Journal of Clinical Gastroenterology, Vol. 50, No. 2, 2016, p. 175-179.

Research output: Contribution to journalArticle

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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.",
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AU - Yopp, Adam

AU - Waljee, Akbar K.

AU - Singal, Amit G.

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N2 - 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.

AB - 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.

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KW - Liver cancer

KW - Risk factors

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