Nabihah Tayob1, Anna S F Lok2, Kim-Anh Do3, Ziding Feng3. 1. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: ntayob@mdanderson.org. 2. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan. 3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) has limited treatment options when diagnosed at advanced stages; therefore, early detection is critical to reduce mortality. There is disagreement about the value of α-fetoprotein (AFP) in HCC surveillance. We aim to improve the sensitivity of AFP in HCC surveillance by using an algorithm that incorporates screening history to define patient-specific thresholds for positive a screen. METHODS: De-identified data from the Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) trial, which enrolled 1050 patients with hepatitis C and advanced fibrosis or cirrhosis who were prospectively followed every 3-6 months, were analyzed. AFP was assayed at each visit, and ultrasonography was performed every 6-12 months. A panel adjudicated the diagnosis of HCC. A parametric empirical Bayes (PEB) screening algorithm, which incorporates screening history, was compared with a single threshold approach for interpreting AFP results. RESULTS: During a median follow-up of 80 months, 88 patients (48 of 427 with cirrhosis and 40 of 621 with advanced fibrosis) were diagnosed with HCC. PEB improved the sensitivity of AFP for detecting all HCC from 60.4% to 77.1% (P < .0005) in patients with cirrhosis and from 72.5% to 87.5% (P = .0015) in patients with advanced fibrosis, when the false-positive rate among all screenings was set at 10%. PEB algorithm detected HCC 1.7-1.9 years earlier in the cirrhosis group and 1.4-1.7 years earlier in the advanced fibrosis group, compared with single threshold approach. CONCLUSIONS: PEB increases the sensitivity of AFP testing and detects HCC earlier among hepatitis C patients with advanced fibrosis or cirrhosis. These data should prompt a reevaluation of how AFP is used in combination with ultrasound in HCC surveillance.
BACKGROUND & AIMS:Hepatocellular carcinoma (HCC) has limited treatment options when diagnosed at advanced stages; therefore, early detection is critical to reduce mortality. There is disagreement about the value of α-fetoprotein (AFP) in HCC surveillance. We aim to improve the sensitivity of AFP in HCC surveillance by using an algorithm that incorporates screening history to define patient-specific thresholds for positive a screen. METHODS: De-identified data from the Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) trial, which enrolled 1050 patients with hepatitis C and advanced fibrosis or cirrhosis who were prospectively followed every 3-6 months, were analyzed. AFP was assayed at each visit, and ultrasonography was performed every 6-12 months. A panel adjudicated the diagnosis of HCC. A parametric empirical Bayes (PEB) screening algorithm, which incorporates screening history, was compared with a single threshold approach for interpreting AFP results. RESULTS: During a median follow-up of 80 months, 88 patients (48 of 427 with cirrhosis and 40 of 621 with advanced fibrosis) were diagnosed with HCC. PEB improved the sensitivity of AFP for detecting all HCC from 60.4% to 77.1% (P < .0005) in patients with cirrhosis and from 72.5% to 87.5% (P = .0015) in patients with advanced fibrosis, when the false-positive rate among all screenings was set at 10%. PEB algorithm detected HCC 1.7-1.9 years earlier in the cirrhosis group and 1.4-1.7 years earlier in the advanced fibrosis group, compared with single threshold approach. CONCLUSIONS: PEB increases the sensitivity of AFP testing and detects HCC earlier among hepatitis Cpatients with advanced fibrosis or cirrhosis. These data should prompt a reevaluation of how AFP is used in combination with ultrasound in HCC surveillance.
Authors: Richard K Sterling; Elizabeth C Wright; Timothy R Morgan; Leonard B Seeff; John C Hoefs; Adrian M Di Bisceglie; Jules L Dienstag; Anna S Lok Journal: Am J Gastroenterol Date: 2011-09-20 Impact factor: 10.864
Authors: Anna S Lok; James E Everhart; Elizabeth C Wright; Adrian M Di Bisceglie; Hae-Young Kim; Richard K Sterling; Gregory T Everson; Karen L Lindsay; William M Lee; Herbert L Bonkovsky; Jules L Dienstag; Marc G Ghany; Chihiro Morishima; Timothy R Morgan Journal: Gastroenterology Date: 2010-12-01 Impact factor: 22.682
Authors: Purva Gopal; Adam C Yopp; Akbar K Waljee; Jason Chiang; Mahendra Nehra; Pragathi Kandunoori; Amit G Singal Journal: Clin Gastroenterol Hepatol Date: 2013-10-02 Impact factor: 11.382
Authors: Charles W Drescher; Chirag Shah; Jason Thorpe; Kathy O'Briant; Garnet L Anderson; Christine D Berg; Nicole Urban; Martin W McIntosh Journal: J Clin Oncol Date: 2012-12-17 Impact factor: 44.544
Authors: Anna S Lok; Leonard B Seeff; Timothy R Morgan; Adrian M di Bisceglie; Richard K Sterling; Teresa M Curto; Gregory T Everson; Karen L Lindsay; William M Lee; Herbert L Bonkovsky; Jules L Dienstag; Marc G Ghany; Chihiro Morishima; Zachary D Goodman Journal: Gastroenterology Date: 2008-09-18 Impact factor: 22.682
Authors: Jorge A Marrero; Ziding Feng; Yinghui Wang; Mindie H Nguyen; Alex S Befeler; Lewis R Roberts; K Rajender Reddy; Denise Harnois; Josep M Llovet; Daniel Normolle; Jackie Dalhgren; David Chia; Anna S Lok; Paul D Wagner; Sudhir Srivastava; Myron Schwartz Journal: Gastroenterology Date: 2009-04-09 Impact factor: 22.682
Authors: Kristina Tzartzeva; Joseph Obi; Nicole E Rich; Neehar D Parikh; Jorge A Marrero; Adam Yopp; Akbar K Waljee; Amit G Singal Journal: Gastroenterology Date: 2018-02-06 Impact factor: 22.682
Authors: Nabihah Tayob; Israel Christie; Peter Richardson; Ziding Feng; Donna L White; Jessica Davila; Douglas A Corley; Fasiha Kanwal; Hashem B El-Serag Journal: Clin Gastroenterol Hepatol Date: 2018-12-14 Impact factor: 11.382