Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project

Rogal, Shari S.; Taddei, Tamar H.; Monto, Alexander; Yakovchenko, Vera; Patton, Heather; Merante, Monica; Spoutz, Patrick; Chia, Linda; Yudkevich, Jennifer; Aytaman, Ayse; Rabiee, Atoosa; John, Binu; Blechacz, Boris; Cai, Cindy X.; Gilles, HoChong; Shah, Anand S.; McCurdy, Heather; Puri, Puneet; Jou, Janice H.; Mazhar, Khurram; Dominitz, Jason A.; Anwar, Jennifer; Morgan, Timothy R.; Ioannou, George N.

doi:10.1016/j.cgh.2023.07.002

Clinical Gastroenterology and Hepatology

2024

DOI: 10.1016/j.cgh.2023.07.002

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Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project

Shari S. Rogal

Tamar H. Taddei

Alexander Monto

et al.

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2024

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“…Too often, the blame is placed on patients or attributed to individual failures when, in fact, the issues are related to systematic factors. For example, between 20% and 80% of Veterans with cirrhosis receive HCC screening, entirely dependent on the Veterans Affairs (VA) hospital in which they are receiving care 2 . Care in the US private sector is worse—while the current average rate of HCC screening in the VA is ~50%, in other hospital settings, rates are under 30% 3 .…”

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confidence: 99%

Introduction: Approaches to improve the quality of care for people with cirrhosis

Rogal,

Fortune

2024

Clinical Liver Disease

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confidence: 99%

Introduction: Approaches to improve the quality of care for people with cirrhosis

Rogal,

Fortune

2024

Clinical Liver Disease

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Access to Evaluation for Liver Transplantation in the Veterans Health Administration

Yakovchenko,

Chang,

Hernaez

et al. 2024

Dig Dis Sci

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Predicting long-term survival among patients with HCC

Goldberg,

Reese,

Kaplan

et al. 2024

Hepatology Communications

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Background: Prognosticating survival among patients with HCC and cirrhosis must account for both the tumor burden/stage, as well as the severity of the underlying liver disease. Although there are many staging systems used to guide therapy, they have not been widely adopted to predict patient-level survival after the diagnosis of HCC. We sought to develop a score to predict long-term survival among patients with early- to intermediate-stage HCC using purely objective criteria. Methods: Retrospective cohort study among patients with HCC confined to the liver, without major medical comorbidities within the Veterans Health Administration from 2014 to 2023. Tumor data were manually abstracted and combined with clinical and laboratory data to predict 5-year survival from HCC diagnosis using accelerated failure time models. The data were randomly split using a 75:25 ratio for training and validation. Model discrimination and calibration were assessed and compared to other HCC staging systems. Results: The cohort included 1325 patients with confirmed HCC. A risk score using baseline clinical, laboratory, and HCC-related survival had excellent discrimination (integrated AUC: 0.71 in the validation set) and calibration (based on calibration plots and Brier scores). Models had superior performance to the BCLC and ALBI scores and similar performance to the combined BCLC-ALBI score. Conclusions: We developed a risk score using purely objective data to accurately predict long-term survival for patients with HCC. This score, if validated, can be used to prognosticate survival for patients with HCC, and, in the setting of liver transplantation, can be incorporated to consider the net survival benefit of liver transplantation versus other curative options.

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Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project

Cited by 3 publications

References 29 publications

Introduction: Approaches to improve the quality of care for people with cirrhosis

Introduction: Approaches to improve the quality of care for people with cirrhosis

Access to Evaluation for Liver Transplantation in the Veterans Health Administration

Predicting long-term survival among patients with HCC

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