Development and Validation of a Noninvasive Model for the Detection of High-Risk Varices in Patients with Unresectable HCC.

Autor:	Parikh ND; University of Michigan, Ann Arbor, Michigan. Electronic address: ndparikh@med.umich.edu., Jones P; University of Miami, Miami, Florida., Salgia R; Henry Ford Health, Detroit, Michigan., Bhan I; Massachusetts General Hospital, Boston, Massachusetts., Grinspan LT; The Mount Sinai Hospital, New York, New York., Jou JH; Oregon Health Science University, Portland, Oregon., Zhou K; University of Southern California, Los Angeles, California., Jalal P; Baylor College of Medicine, Houston, Texas., Roccaro G; Emory University, Atlanta, Georgia., Rangnekar AS; Georgetown University, Washington, District of Columbia., Benhammou JN; University of California Los Angeles, Los Angeles, California., Pillai A; University of Chicago, Chicago, Illinois., Mehta N; University of San Francisco, San Francisco, California., Wedd J; Virginia Commonwealth University, Richmond, Virginia., Yang JD; Cedars-Sinai Medical Center, Los Angeles, California., Kim AK; Johns Hopkins University, Baltimore, Maryland., Duarte-Rojo A; Northwestern University, Chicago, Illinois., Oloruntoba OO; Duke University, Durham, North Carolina., Tevar A; University of Pittsburgh, Pittsburgh, Pennsylvania., Au JS; Scripps Health, San Diego, California., Blain Y; University of Miami, Miami, Florida., Rao S; University of Miami, Miami, Florida., Catalano OA; Massachusetts General Hospital, Boston, Massachusetts., Lewis S; The Mount Sinai Hospital, New York, New York., Mendiratta-Lala M; University of Michigan, Ann Arbor, Michigan., King K; University of Southern California, Los Angeles, California., Sachdev L; Georgetown University, Washington, District of Columbia., Lee EW; University of California Los Angeles, Los Angeles, California., Bruno J; Virginia Commonwealth University, Richmond, Virginia., Kamel I; Johns Hopkins University, Baltimore, Maryland., Tolosa C; Johns Hopkins University, Baltimore, Maryland., Kao K; University of Michigan, Ann Arbor, Michigan., Badawi T; Henry Ford Health, Detroit, Michigan., Przybyszewski EM; Massachusetts General Hospital, Boston, Massachusetts., Quirk L; University of Texas Southwestern, Dallas, Texas., Nathani P; University of Texas Southwestern, Dallas, Texas., Haydel B; The Mount Sinai Hospital, New York, New York., Leven E; The Mount Sinai Hospital, New York, New York., Wong N; Oregon Health Science University, Portland, Oregon., Albertian R; University of Southern California, Los Angeles, California., Chen A; University of Southern California, Los Angeles, California., Aloor FZ; Baylor College of Medicine, Houston, Texas., Mohamed IB; Baylor College of Medicine, Houston, Texas., Elkheshen A; Baylor College of Medicine, Houston, Texas., Marvil C; Emory University, Atlanta, Georgia., Issac G; Emory University, Atlanta, Georgia., Clinton JW; Georgetown University, Washington, District of Columbia., Woo SM; Georgetown University, Washington, District of Columbia., Yum J; University of California Los Angeles, Los Angeles, California., Rieger E; University of Chicago, Chicago, Illinois., Hutchison AL; University of Chicago, Chicago, Illinois., Turner DA; Virginia Commonwealth University, Richmond, Virginia., Alsudaney M; Cedars-Sinai Medical Center, Los Angeles, California., Hernandez P; Cedars-Sinai Medical Center, Los Angeles, California., Xu Z; Johns Hopkins University, Baltimore, Maryland., Khalid A; Scripps Health, San Diego, California., Barrick B; Scripps Health, San Diego, California., Wang B; University of Michigan, Ann Arbor, Michigan., Tapper EB; University of Michigan, Ann Arbor, Michigan., Hao W; University of Michigan, Ann Arbor, Michigan., Singal AG; University of Texas Southwestern, Dallas, Texas.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Jul 30. Date of Electronic Publication: 2024 Jul 30.
DOI:	10.1016/j.cgh.2024.07.008
Abstrakt:	Background & Aims: Noninvasive variceal risk stratification systems have not been validated in patients with hepatocellular carcinoma (HCC), which presents logistical barriers for patients in the setting of systemic HCC therapy. We aimed to develop and validate a noninvasive algorithm for the prediction of varices in patients with unresectable HCC. Methods: We performed a retrospective cohort study in 21 centers in the United States including adult patients with unresectable HCC and Child-Pugh A5-B7 cirrhosis diagnosed between 2007 and 2019. We included patients who completed an esophagogastroduodonoscopy (EGD) within 12 months of index imaging but before HCC treatment. We divided the cohort into a 70:30 training set and validation set, with the goal of maximizing negative predictive value (NPV) to avoid EGD in low-risk patients. Results: We included 707 patients (median age, 64.6 years; 80.6% male; 74.0% White). Median time from HCC diagnosis to EGD was 47 (interquartile range, 114) days, with 25.0% of patients having high-risk varices. A model using clinical variables alone achieved an NPV of 86.3% in the validation cohort, whereas a model integrating clinical and imaging variables had an NPV 97.4% in validation. The clinical and imaging model would avoid EGDs in more than half of low-risk patients while misclassifying 7.7% of high-risk patients. Conclusions: A model incorporating clinical and imaging data can accurately predict the absence of high-risk varices in patients with HCC and avoid EGD in many low-risk patients before the initiation of systemic therapy, thus expediting their care and avoiding treatment delays. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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