Patient Preferences for Hepatocellular Carcinoma Surveillance Parameters

Woolen, Sean; Singal, Amit G.; Davenport, Matthew S.; Troost, Jonathan P.; Khalatbari, Shokoufeh; Mittal, Sukul; Siddiqui, Sehar; Fobar, Austin J.; Morris, Jason; Odewole, Mobolaji; Tapper, Elliot B.; Pillai, Anjana; Parikh, Neehar D.

doi:10.1016/j.cgh.2021.02.024

Cited by 43 publications

(28 citation statements)

References 32 publications

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“…Patients also appear to prefer biomarker-based surveillance to ultrasound, if it can achieve adequate sensitivity for early-stage HCC detection. [34] Therefore, a blood-based biomarker could improve surveillance effectiveness even if it has similar sensitivity for early HCC detection as ultrasound-based surveillance. While our results are encouraging for biomarkerbased surveillance, the limited number of incident HCCs resulted in wide CIs and hence preclude us from making statements about statistically significant improvements.…”

Section: Discussionmentioning

confidence: 99%

GALAD demonstrates high sensitivity for HCC surveillance in a cohort of patients with cirrhosis

et al. 2021

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Background and Aims: Most patients with HCC are diagnosed at a late stage, highlighting the need for more accurate surveillance tests. Although biomarkers for HCC early detection have promising data in Phase 2 casecontrol studies, evaluation in cohort studies is critical prior to adoption in practice. We leveraged a prospective cohort of patients with Child-Pugh A or B cirrhosis who were followed until incident HCC, liver transplantation, death, or loss to follow-up. We used a prospective specimen collection, retrospective, blinded evaluation design for biomarker evaluation of GALAD (gender × age × log alpha-fetoprotein [AFP] × des-gamma-carboxy prothrombin), longitudinal GALAD, and the HCC Early Detection Screening (HES) algorithm-compared to AFP-using patient-level sensitivity and screening-level specificity. Approach and Results:Of 397 patients with cirrhosis, 42 developed HCC (57.1% early stage) over a median of 2.0 years. Longitudinal GALAD had the highest c-statistic for HCC detection (0.85; 95% CI, 0.77-0.92) compared to single-time point GALAD (0.79; 95% CI, 0.71-0.87), AFP (0.77; 95% CI, 0.69-0.85), and HES (0.76; 95% CI, 0.67-0.83). When specificity was fixed at 90%, the sensitivity for HCC of single-time point and longitudinal GALAD was 54.8% and 66.7%, respectively, compared to 40.5% for AFP. Sensitivity for HCC detection was higher when restricted to patients with biomarker assessment within 6 months prior to HCC diagnosis, with the highest sensitivities observed for single-time point GALAD (72.0%) and longitudinal GALAD (64.0%), respectively. Sensitivity of single-time point and longitudinal GALAD for early-stage HCC was 53.8% and 69.2%, respectively. Conclusion:GALAD demonstrated high sensitivity for HCC detection in a cohort of patients with cirrhosis. Validation of these results is warranted in large Phase 3 data sets.

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Section: Discussionmentioning

confidence: 99%

GALAD demonstrates high sensitivity for HCC surveillance in a cohort of patients with cirrhosis

et al. 2021

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“…30,31 The mt-HBT leverages information from both DNA methylation and protein biomarkers (along with patient sex) obtained from a single blood specimen collection. Furthermore, results from a recent HCC surveillance modeling study suggested a higher preference for blood-based tests over U/S AE AFP because of the increased convenience Q18 and shorter time commitment required, 32 indicating their potential usefulness in the clinic.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Novel Multitarget Blood Test Shows High Sensitivity to Detect Early Stage Hepatocellular Carcinoma

Chalasani

Porter

Bhattacharya

et al. 2022

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Q9Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. Although biannual ultrasound surveillance with or without a-fetoprotein (AFP) testing is recommended for at-risk patients, sensitivity for early stage HCC, for which potentially curative treatments exist, is suboptimal. We conducted studies to establish the multitarget HCC blood test (mt-HBT) algorithm and cut-off values and to validate test performance in patients with chronic liver disease.

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“…In parallel, increasing data suggest HCC surveillance blood‐based biomarker panels, such as GALAD or Liver OncoGuard, may also achieve high sensitivity for early‐stage HCC detection ‐ including in those with obesity and non‐viral liver disease 31‐33 . Biomarker‐based surveillance would have the additional benefit of addressing patient‐ and provider‐reported barriers to surveillance, and thereby increasing surveillance utilisation in clinical practice 34,35 …”

Section: Discussionmentioning

confidence: 99%

Association between ultrasound quality and test performance for HCC surveillance in patients with cirrhosis: a retrospective cohort study

Chong

Schoenberger

Yekkaluri

et al. 2022

Aliment Pharmacol Ther

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Background: Ultrasound visualisation is limited in approximately 20% of patients with cirrhosis undergoing hepatocellular carcinoma (HCC) surveillance; however, it is unknown if impaired visualisation directly impacts test performance. We aimed to evaluate the association between ultrasound visualisation and surveillance test performance. Methods:We performed a retrospective cohort study among patients with cirrhosis, with or without HCC, who underwent ultrasound-based surveillance at two large health systems between July 2016 and July 2019. Ultrasound visualisation assessment was recorded by interpreting radiologists using the ultrasound LI-RADS Visualisation score. We performed logistic regression analyses to evaluate the association between ultrasound visualisation and diagnostic test performance. We assessed sensitivity for HCC detection among ultrasounds performed in the year prior to HCC diagnoses and specificity using ultrasounds in those without HCC.Results: Among 186 patients with HCC, severely limited visualisation (Vis Score C) on ultrasound prior to HCC diagnosis was associated with increased odds of falsenegative results, that is lower sensitivity (OR 7.94, in multivariable analysis. Ultrasound sensitivity with visualisation scores A or B exceeded 75%, compared to only 27.3% with visualisation score C. Among 2052 cirrhosis patients without HCC, moderate visualisation limitations (Vis score B) were associated with increased odds of false-positive results (OR 1.60, 1.13-2.27), although specificity exceeded 95% across all visualisation scores. Conclusions: Impaired ultrasound visualisation is associated with worse surveillance test performance. Alternative blood-based biomarkers and imaging strategies are needed for patients at risk for ultrasound-based surveillance failure.

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Patient Preferences for Hepatocellular Carcinoma Surveillance Parameters

Cited by 43 publications

References 32 publications

GALAD demonstrates high sensitivity for HCC surveillance in a cohort of patients with cirrhosis

GALAD demonstrates high sensitivity for HCC surveillance in a cohort of patients with cirrhosis

Validation of a Novel Multitarget Blood Test Shows High Sensitivity to Detect Early Stage Hepatocellular Carcinoma

Association between ultrasound quality and test performance for HCC surveillance in patients with cirrhosis: a retrospective cohort study

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