Novel Application of Predictive Modeling: A Tailored Approach to Promoting HCC Surveillance in Patients With Cirrhosis

Singal, Amit G.; Chen, Yixing; Sridhar, Shrihari; Mittal, Vikas; Fullington, Hannah; Shaik, Muzeeb; Waljee, Akbar K.; Tiro, Jasmin A.

doi:10.1016/j.cgh.2021.02.038

Cited by 11 publications

(5 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…A proof-of-concept analysis suggested that this strategy would be feasible and cost-effective. 20,21 Furthermore, as evidence builds for biomarker-based surveillance, with several maturing phase III biomarker cohorts, [22][23][24] there may be improved surveillance adherence with increased patient acceptance and removal of logistical barriers to surveillance completion. 25 Routine measurement and reporting of surveillance receipt as a quality metric for hepatology care has been proposed; however, our study highlights a couple of points to consider.…”

Section: Discussionmentioning

confidence: 99%

“…We observed significant site-level variation in surveillance attainment, highlighting particular opportunities to target interventions at low-performing sites or patients at high risk of surveillance failure. A proof-of-concept analysis suggested that this strategy would be feasible and cost-effective . Furthermore, as evidence builds for biomarker-based surveillance, with several maturing phase III biomarker cohorts, there may be improved surveillance adherence with increased patient acceptance and removal of logistical barriers to surveillance completion …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCEHepatocellular carcinoma (HCC) surveillance is underused in clinical practice, which may be owing to patient and clinician barriers. OBJECTIVE To characterize HCC surveillance barriers and associations with clinical outcomes in a multicenter cohort of patients with cirrhosis. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included 5 medical centers in the United States. Patients with cirrhosis and newly diagnosed HCC treated from 2014 to 2018 were included. Data were analyzed from June 2021 to February 2022. EXPOSURE Surveillance completion in the 36-month period prior to HCC diagnosis. MAIN OUTCOMES AND MEASURES Surveillance receipt was classified as semiannual, annual, or no surveillance. Multivariable logistic regression analysis was used to identify factors associated with semiannual surveillance. We conducted multivariable logistic and Cox regression analyses to characterize associations between surveillance completion with curative treatment and overall survival. RESULTS A total 629 eligible patients (median [IQR] age, 63.6 [56.2-71.0] years; 491 [78.1%] men) were assessed, including 7 American Indian or Alaska Native patients (1.1%), 14 Asian patients (2.2), 176 Black patients (28.0%), 86 Hispanic patients (13.1%), and 340 White patients (54.1%). Nearly two-thirds of the cohort had no surveillance prior to HCC diagnosis (mean [range by site] 63.7%[37.9%-80.4%]), with a mean (range by site) of 14.0% (5.3%-33.3%) of patients having received semiannual surveillance and 22.3% (14.3%-28.8%) of patients having received annual surveillance.The most common reasons for no surveillance were lack of surveillance orders or nonadherence (mean [range by site], 82.4% [66.7%-92.4%], although a mean (range by site) of 17.6% (10.2%-22.1%) of patients had unrecognized cirrhosis at HCC presentation. Semiannual surveillance was associated with hepatitis B infection (odds ratio [OR], 3.06 [95% CI, 1.24-7.23]) and inversely associated with Black race (OR, 0.41 [95% CI, 0.20-0.80]) and lack of cirrhosis recognition (OR, 0.14 [95% CI, 0.02-0.46]). Semiannual HCC surveillance was significantly associated with curative treatment receipt (OR, 2.73 [95% CI, 1.60-4.70]) but not overall survival (HR, 0.81 [95% CI, 0.55-1.18]). CONCLUSIONS AND RELEVANCEIn this cohort study of patients with cirrhosis, HCC surveillance was underused in more than 80% of patients and associated with failures across the screening process. Dedicated programs to improve cirrhosis detection and HCC surveillance attainment are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Another United States survey identified patient-reported barriers to surveillance as knowledge deficits about HCC surveillance, cost, difficulty scheduling and transportation[ 144 ]. Individualized predictive modeling for risk stratification in patients with cirrhosis can facilitate and improve the cost-effectiveness of surveillance[ 145 , 146 ].…”

Section: Epidemiology Of Hcc In Liver Cirrhosismentioning

confidence: 99%

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liu¹,

Chen²

2022

World J Gastroenterol

View full text Add to dashboard Cite

Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

show abstract

“…It has the 5th highest incidence and is the 3rd leading cause of cancer-related deaths among cancers, and about 80% of all primary liver cancers are HCC in China (2,3). Due to a lack of effective diagnostic biomarkers and obvious symptoms in the early stages of HCC, most patients suffering from liver cancer are only diagnosed at an advanced stage with malignant metastases (4). Newly developed medical treatments, such as transplantation, chemotherapy, radiotherapy, immunotherapy, and targeted therapy, partially improve the prospects of HCC patients for whom prognosis is bleak (5,6).…”

Section: Introductionmentioning

confidence: 99%

MiR-448 suppresses cell proliferation and glycolysis of hepatocellular carcinoma through inhibiting IGF-1R expression

Wang¹,

Chen²,

Yao³

et al. 2022

J Gastrointest Oncol

View full text Add to dashboard Cite

Background: Microribonucleic acids (miRNAs) have been shown to play important roles in hepatocellular carcinoma (HCC) progression. MiR-448 has frequently been shown to be a tumor suppressor, and is abnormally expressed in HCC tumor tissues. However, little is known about the role of miR-448 in HCC development. In this article, the regulatory role of miR-448 on insulin-like growth factor 1 receptor (IGF-1R) in modulating hepatoma cell viability and glycolysis was investigated. Methods:The expression of miR-448 profiles in clinical tumor tissues and cell lines was examined using quantitative real-time polymerase chain reaction (qRT-PCR). HepG2 and Huh7 cells were transfected with miR-448 mimics, inhibitors, and scramble sequences. Cell viability and apoptosis were determined by a Cell Counting Kit-8 assay and a flow cytometry analysis. IGF-1R, a potential target of miR-448, was selected following a bioinformatic analysis, and the regulatory effects of miR-448 on IGF-1R expression was confirmed by luciferase reporter assay, qRT-PCR, and western blot. Glucose uptake, lactate production, and adenosine triphosphate (ATP) generation were detected by corresponding kits.Results: Decreased miR-448 expression was observed in both HCC patients' tumor tissues and hepatoma cells in vitro. The overexpression of miR-448 in HepG2 and Huh7 cells decreased cell viability and increased apoptosis. Additionally, the overexpression of miR-448 or the knockdown of IGF-1R lowered the level of glucose uptake, lactate production, and ATP generation, while the knockdown of miR-448 increased glycolysis. Further, aberrantly expressed miR-448 downregulated IGF-1R levels, while the inhibition of miR-448 resulted in the upregulation of IGF-1R in both HepG2 and Huh7 cells. In addition, miR-448 interacted with the wild-type 3'untranslated regions (3'UTRs) of IGF-1R, but had no effect on the mutant 3'UTRs.The expression of IGF-1R was increased in HCC patients' tumor tissues and serum, and was inversely correlated with miR-448 expression. Conclusions:The increased expression of miR-448 appears to downregulate the expression of IGF-1R by interacting with the 3'UTR in HCC progression. These findings highlight its role as a potential target for HCC therapy.

show abstract

Novel Application of Predictive Modeling: A Tailored Approach to Promoting HCC Surveillance in Patients With Cirrhosis

Cited by 11 publications

References 35 publications

Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort

Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

MiR-448 suppresses cell proliferation and glycolysis of hepatocellular carcinoma through inhibiting IGF-1R expression

Contact Info

Product

Resources

About