Surveillance of Hepatocellular Carcinoma in Cirrhotic Patients: Current Knowledge and Future Directions

Demirtaş, Coşkun Özer

doi:10.14744/hf.2020.2020.0003

Cited by 5 publications

(7 citation statements)

References 65 publications

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“…Liver cirrhosis plays an important role in HCC development 1,4,5 . Patients with cirrhosis are at the highest risk for developing HCC, with a variable annual risk of 1%‐8% 6 . Liver fibrosis occurs in various liver diseases and is characterised by excessive accumulation of extracellular matrix.…”

Section: Introductionmentioning

confidence: 99%

“…1,4,5 Patients with cirrhosis are at the highest risk for developing HCC, with a variable annual risk of 1%-8%. 6 Liver fibrosis occurs in various liver diseases and is characterised by excessive accumulation of extracellular matrix. Hepatic stellate cells are an important factor of liver fibrogenesis, which implicates multiple mechanisms and proteins such as TGF-beta 1, angiotensin II and leptin.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and novel application of FibroScan, FIB‐4 and aspartate aminotransferase‐to‐platelet ratio index in liver fibrosis evaluation in patients with hepatocellular carcinoma and their roles in oesophageal variceal prediction

et al. 2021

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Background Non‐invasive techniques for liver fibrosis diagnosis are very important for clinician especially in high‐risk patients for liver biopsy. We further explored the diagnostic accuracy of FibroScan, FIB‐4 and aminotransferase‐to‐platelet ratio index (APRI) in identifying liver fibrosis and assess their predictive role for oesophageal varices in patients with hepatocellular carcinoma (HCC). Methods In total, 380 patients who underwent surgery for HCC were included based on retrospective study design. Liver fibrosis was pathologically diagnosed using the Ishak scoring system. Liver stiffness parameters were measured using FibroScan. APRI and FIB‐4 were calculated. Among those, 121 patients who received oesophagogastroduodenoscopic examination underwent variceal evaluation. Results For liver cirrhosis diagnosis with FibroScan, the optimal cut‐off values for the patients with HCC overall, left HCC and right HCC were 8.85, 11.75 and 8.70 kPa (the accuracy were 78.7%, 78.4% and 79.2%, respectively). They had high areas under the receiver operating characteristic curve of 0.84, 0.84 and 0.85. The combined FibroScan, APRI and FIB‐4 had very high specificity (more than 92%) for cirrhosis diagnosis. The optimal cut‐off liver stiffness values for the diagnosis of varices were all 11.2 kPa. For predicting varices, the optimal cut‐off values of FIB‐4 and APRI were 2.64 and 0.71, their accuracy were 64.3%‐78.4%, 69.4% and 72.7%, respectively. Conclusions FibroScan, FIB‐4 and APRI have moderate accuracy for liver fibrosis diagnosis and oesophageal varices prediction in patients with hepatoma. This is a study of these non‐invasive techniques applied in specific hepatoma patients and with inevitable limitations and need future more studies for validation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and novel application of FibroScan, FIB‐4 and aspartate aminotransferase‐to‐platelet ratio index in liver fibrosis evaluation in patients with hepatocellular carcinoma and their roles in oesophageal variceal prediction

et al. 2021

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“…Several scoring systems were developed to predict the risk of HCC, mainly from Asian cohorts, to stratify the HCC prediction in patients with CHB. Similarly, even if less than for CHB, a few scoring systems were developed for CHC patients or cirrhotic patients with chronic liver diseases of different etiologies [16].…”

Section: Recent Advances In Hcc Surveillancementioning

confidence: 99%

Surveillance Strategies for Hepatocellular Carcinoma: Recent Advances and the Shifting Paradigm

Demirtaş

Gündüz

Özdoğan

2021

J Gastrointest Canc

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Currently, international liver societies recommend screening at-risk individuals for HCC (patients with cirrhosis regardless of etiology, and/or chronic hepatitis B virus, and/or advanced liver fibrosis) with biannual abdominal ultrasound (USG) with or without alpha-fetoprotein (AFP). The global acceptance of USG in surveillance relies on the absence of risks, non-invasiveness, and lower costs. However, the suboptimal performance of USG ± AFP in reaching direct and indirect goals of HCC surveillance highlights the need for alternative surveillance strategies. Several studies targeted contrast-enhanced magnetic resonance imaging techniques, but the main barriers for their entrance to surveillance programs have been concerns about cost-effectivity and long scan times. Overall, the HCC risk stratification appears at hand by several validated multiple score systems, but their optimal performance is obtained only in populations who show highly homogenous clinical, pathological, epidemiologic, etiologic, and therapeutic characteristics, and this limitation poses a major drawback to their sustainable use in clinical practice. We need globally validated and molecular integrated risk stratification tools to shape the future tailored HCC surveillance decision algorithms. A dynamic process for HCC surveillance algorithms awaits us owing to the expected further prospective studies focusing on risk-stratified screening strategy.

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“…The key to increasing the yield and cost-effectiveness lies in a risk-stratified surveillance strategy. 13 In this study, we first focused on serum markers that had recently become available, namely, Wisteria floribunda agglutinin+-Mac-2 binding protein (WFA+-M2BP; M2BPGi), 14,15 autotaxin (ATX), 16 platelet count, 17 and the fibrosis-4 (FIB-4) index, 18 to generate data that took into consideration HCC patients in the clinic. Next, we analyzed the elastography data using ultrasound (US) 19,20 and MRI [21][22][23][24][25] to efficiently predict the following: collateral circulation (with high sensitivity), characteristics associated with liver stiffness and liver function, and HCC occurrence depending on the etiology.…”

Section: Introductionmentioning

confidence: 99%

“…HCC surveillance with ultrasound elastography (USE) ± α‐fetoprotein (AFP) does not constitute direct physical harm; however, frequently observed false negative results require subsequent computed tomography and/or magnetic resonance imaging (MRI) at shorter intervals, which increases radiation exposure, possible contrast injury, and financial burden. The key to increasing the yield and cost‐effectiveness lies in a risk‐stratified surveillance strategy 13 …”

Section: Introductionmentioning

confidence: 99%

Screening and follow‐up of chronic liver diseases with understanding their etiology in clinics and hospitals

et al. 2020

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Surveillance of Hepatocellular Carcinoma in Cirrhotic Patients: Current Knowledge and Future Directions

Cited by 5 publications

References 65 publications

Clinical and novel application of FibroScan, FIB‐4 and aspartate aminotransferase‐to‐platelet ratio index in liver fibrosis evaluation in patients with hepatocellular carcinoma and their roles in oesophageal variceal prediction

Clinical and novel application of FibroScan, FIB‐4 and aspartate aminotransferase‐to‐platelet ratio index in liver fibrosis evaluation in patients with hepatocellular carcinoma and their roles in oesophageal variceal prediction

Surveillance Strategies for Hepatocellular Carcinoma: Recent Advances and the Shifting Paradigm

Screening and follow‐up of chronic liver diseases with understanding their etiology in clinics and hospitals

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