HCC surveillance in hepatitis C: A longitudinal algorithm improves alpha-fetoprotein screening.

IF 5.6 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Communications Pub Date : 2025-05-23 eCollection Date: 2025-06-01 DOI:10.1097/HC9.0000000000000719
Tracey L Marsh, Janet M Johnston, Chriss Homan, Lisa J Townshend-Bulson, Nicole J Kim, Trang VoPham, Xiaohong Li, Qianchuan He, Brian J McMahon, George N Ioannou, Ziding Feng
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引用次数: 0

Abstract

Background: Surveillance for HCC remains important after hepatitis C cure. Improved sensitivity of screening with alpha-fetoprotein (AFP) by using a parametric empirical Bayes (PEB) algorithm, which incorporates an individual patient's longitudinal AFP measurements, was previously demonstrated in a retrospective analysis of clinical trial data prior to widespread hepatitis C cure.

Methods: We analyzed de-identified data extracted from the medical records of participants in the Alaska Hepatitis C Study, which aims to enroll all Alaska Native persons living in Alaska with a history of hepatitis C.We compared the performance characteristics of AFP as a screening test using the PEB method versus a fixed cutoff (FC) method in an observational setting, separately for HCC surveillance in active and cured hepatitis C.

Results: The PEB and FC methods were applied to AFP levels from participants with F3/F4 fibrosis who had active hepatitis C (173 no HCC, 14 HCC) or after they achieved hepatitis C cure (162 no HCC, 12 HCC). Compared to a fixed 20 ng/mL cutoff, demonstrating 91.2% specificity in active hepatitis C, PEB increased sensitivity from 64.3% to 71.4%. After cure, a fixed 7.2 ng/mL cutoff demonstrated 91.2% specificity, and PEB increased sensitivity from 58.3% to 91.7%.

Conclusions: The PEB algorithm can increase sensitivity and lead to earlier detection of HCC among patients with F3/F4 fibrosis, both in active and even more so in cured hepatitis C. Lower AFP levels after cure indicate that for either PEB or FC methods, screening parameters, such as cutoffs for a target specificity, should be specified separately by hepatitis C treatment status for HCC surveillance.

丙型肝炎HCC监测:纵向算法改善甲胎蛋白筛查。
背景:丙型肝炎治愈后肝细胞癌的监测仍然很重要。使用参数经验贝叶斯(PEB)算法提高了甲胎蛋白(AFP)筛查的敏感性,该算法结合了个体患者的纵向AFP测量,此前在丙型肝炎广泛治愈之前的临床试验数据回顾性分析中得到证实。方法:我们分析了从阿拉斯加丙型肝炎研究参与者的医疗记录中提取的去识别数据,该研究旨在招募居住在阿拉斯加的所有有肝炎病史的阿拉斯加原住民C.We,比较了AFP作为筛查试验的性能特征,使用PEB方法与观察环境中的固定截止(FC)方法,分别用于活动性和治愈型丙型肝炎的HCC监测。PEB和FC方法应用于F3/F4纤维化的活动性丙型肝炎患者(173例无HCC, 14例HCC)或丙型肝炎治愈后(162例无HCC, 12例HCC)的AFP水平。与固定的20 ng/mL临界值相比,PEB对活动性丙型肝炎的特异性为91.2%,敏感性从64.3%提高到71.4%。治愈后,固定的7.2 ng/mL临界值显示出91.2%的特异性,PEB将敏感性从58.3%提高到91.7%。结论:PEB算法可以提高F3/F4纤维化患者的敏感性,使其更早发现HCC,无论是活动性丙型肝炎患者,还是治愈的丙型肝炎患者,治愈后AFP水平较低表明,无论是PEB方法还是FC方法,筛查参数,如靶特异性的截止点,都应根据丙型肝炎治疗状态单独指定,以进行HCC监测。
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来源期刊
Hepatology Communications
Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
8.00
自引率
2.00%
发文量
248
审稿时长
8 weeks
期刊介绍: Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction. ​
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