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Hepatocellular Cancer Surveillance in Patients with Advanced Chronic Liver Disease
W. Gu, V. de Lédinghen, C. Aubé, A. Krag, C. Strassburg, L. Castéra, J. Dumortier, M. Friedrich-Rust, S. Pol, I. Grgurevic, Y. Zeleke, M. Praktiknjo, R. Schierwagen, S. Klein, S. Francque, H. Gottfriedová, I. Sporea, P. Schindler, F. Rennebaum,...
Language English Country United States
Document type Journal Article, Multicenter Study
PubMed
39437136
DOI
10.1056/evidoa2400062
Knihovny.cz E-resources
- MeSH
- Algorithms MeSH
- Chronic Disease MeSH
- Adult MeSH
- Elasticity Imaging Techniques * MeSH
- Carcinoma, Hepatocellular * epidemiology diagnostic imaging diagnosis MeSH
- Middle Aged MeSH
- Humans MeSH
- Liver Neoplasms * epidemiology diagnostic imaging diagnosis MeSH
- Liver Diseases epidemiology diagnostic imaging diagnosis MeSH
- Risk Factors MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
BACKGROUND: Patients with advanced chronic liver disease (ACLD) are at high risk of developing hepatocellular carcinoma (HCC). Therefore, biannual surveillance is recommended. This large-scale multicenter study aimed to stratify the risk of HCC development in ACLD. METHODS: From 3016 patients with ACLD screened in 17 European and Chinese centers, 2340 patients with liver stiffness measurement (LSM) determined using different techniques (two-dimensional shear-wave elastography [2D-SWE], transient elastography, and point shear-wave elastography) and with different disease severities were included. Cox regression was used to explore risk factors for HCC. We used these data to create an algorithm, named PLEASE, but referred to in this manuscript as "the algorithm"; the algorithm was validated in internal and two external cohorts across elastography techniques. RESULTS: HCC developed in 127 (5.4%) patients during follow-up. LSM by 2D-SWE (hazard ratio: 2.28) was found to be associated with developing HCC, alongside age, sex, etiology, and platelet count (C-index: 0.8428). We thus established the algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×109/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Within 2 years, with a median follow-up of 13.7 months, patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%). CONCLUSIONS: Our algorithm stratified patients into two groups: those at higher risk of developing HCC and those at lower risk. Our data provide equipoise to test the prospective utility of the algorithm with respect to clinical decisions about screening patients with ACLD for incident HCC. (Funded by the German Research Foundation and others; ClinicalTrials.gov number, NCT03389152.).
Angers University Hospital and HIFIH Lab University of Angers Angers France
Clinic for Radiology Faculty of Medicine Münster University Münster Germany
Department of Gastroenterology and Hepatology Odense University Hospital Odense Denmark
Department of Gastroenterology Hepatology Antwerp University Hospital Antwerp Belgium
Department of Internal Medicine 1 Bonn University Hospital Bonn Germany
Department of Internal Medicine 1 Frankfurt University Hospital Frankfurt am Main Germany
Department of Internal Medicine B Faculty of Medicine University of Münster Münster Germany
Department of Radiology Beaujon Hospital Clichy France
Department of Ultrasound Zhongshan Hospital Fudan University Shanghai China
Dubrava University Hospital University of Zagreb School of Medicine Zagreb Croatia
European Foundation for the Study of Chronic Liver Failure Barcelona
Fédération des Spécialités Digestives Edouard Herriot Hospital Lyon France
Gastroenterology and Hepatology Victor Babes University of Medicine and Pharmacy Timișoara Romania
Hepatology Unit University Hospital Bordeaux and INSERM U1053 University of Bordeaux Bordeaux France
References provided by Crossref.org
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- $a Gu, Wenyi $u Department of Internal Medicine B, Faculty of Medicine, University of Münster, Münster, Germany $u Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt am Main, Germany
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- $a Hepatocellular Cancer Surveillance in Patients with Advanced Chronic Liver Disease / $c W. Gu, V. de Lédinghen, C. Aubé, A. Krag, C. Strassburg, L. Castéra, J. Dumortier, M. Friedrich-Rust, S. Pol, I. Grgurevic, Y. Zeleke, M. Praktiknjo, R. Schierwagen, S. Klein, S. Francque, H. Gottfriedová, I. Sporea, P. Schindler, F. Rennebaum, MJ. Brol, M. Schulz, FE. Uschner, J. Fischer, C. Margini, W. Wang, A. Delamarre, J. Best, A. Canbay, DJM. Bauer, B. Simbrunner, G. Semmler, T. Reiberger, J. Boursier, DN. Rasmussen, V. Vilgrain, A. Guibal, S. Zeuzem, C. Vassord, L. Vonghia, R. Šenkeříková, A. Popescu, A. Berzigotti, W. Laleman, M. Thiele, C. Jansen, J. Trebicka
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- $a BACKGROUND: Patients with advanced chronic liver disease (ACLD) are at high risk of developing hepatocellular carcinoma (HCC). Therefore, biannual surveillance is recommended. This large-scale multicenter study aimed to stratify the risk of HCC development in ACLD. METHODS: From 3016 patients with ACLD screened in 17 European and Chinese centers, 2340 patients with liver stiffness measurement (LSM) determined using different techniques (two-dimensional shear-wave elastography [2D-SWE], transient elastography, and point shear-wave elastography) and with different disease severities were included. Cox regression was used to explore risk factors for HCC. We used these data to create an algorithm, named PLEASE, but referred to in this manuscript as "the algorithm"; the algorithm was validated in internal and two external cohorts across elastography techniques. RESULTS: HCC developed in 127 (5.4%) patients during follow-up. LSM by 2D-SWE (hazard ratio: 2.28) was found to be associated with developing HCC, alongside age, sex, etiology, and platelet count (C-index: 0.8428). We thus established the algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×109/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Within 2 years, with a median follow-up of 13.7 months, patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%). CONCLUSIONS: Our algorithm stratified patients into two groups: those at higher risk of developing HCC and those at lower risk. Our data provide equipoise to test the prospective utility of the algorithm with respect to clinical decisions about screening patients with ACLD for incident HCC. (Funded by the German Research Foundation and others; ClinicalTrials.gov number, NCT03389152.).
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