Author information
1University of Michigan, Ann Arbor, MI. Electronic address: ndparikh@med.umich.edu.
2University of Miami, Miami, FL.
3Henry Ford Health, Detroit, MI.
4Massachusetts General Hospital, Boston, MA.
5The Mount Sinai Hospital, New York, NY.
6Oregon Health Science University, Portland, OR.
7University of Southern California, Los Angeles, CA.
8Baylor College of Medicine, Houston, TX.
9Emory University, Atlanta, GA.
10Georgetown University, District of Columbia.
11University of California Los Angeles, Los Angeles, CA.
12University of Chicago, Chicago, IL.
13University of San Francisco, San Francisco, CA.
14Virginia Commonwealth University, Richmond, VA.
15Cedars-Sinai Medical Center, Los Angeles, CA.
16Johns Hopkins University, Baltimore, MD.
17Northwestern University, Chicago, IL.
18Duke University, Durham, NC.
19University of Pittsburgh, Pittsburgh, PA.
20Scripps Health, San Diego, CA.
21University of Michigan, Ann Arbor, MI.
22University of Texas Southwestern, Dallas, TX.
Abstract
Background and aims: Non-invasive 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 non-invasive algorithm for the prediction of varices in patients with unresectable HCC.
Methods: We performed a retrospective cohort study in 21 centers in the US including adult patients with unresectable HCC and Child Pugh A5-B7 cirrhosis diagnosed between 2007 and2019. We included patients who completed an esophagogastroduodonoscopy (EGD) within 12 months of index imaging but prior to 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 and 74.0% White). Median time from HCC diagnosis to EGD was 47 (IQR: 114) days, with 25.0% of patients having high-risk varices. A model using clinical variables alone achieved a NPV of 86.3% in the validation cohort, while a model integrating clinical and imaging variables had an NPV 97.4% in validation. The clinical and imaging model would avoid EGDs in over half of low-risk patients while misclassifying 7.7% of high-risk patients.
Conclusion: 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 prior to the initiation of systemic therapy, thus expediting their care and avoiding treatment delays.