Development and Internal Validation of a Model for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis.
Development and Internal Validation of a Model for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis.
复制标题
DOI：
10.1097/mcg.0000000000000377
复制
发表时间：
2016-02
影响因子：
2.9
通讯作者：
Singal AG
中科院分区：
文献类型：
--
作者：
Patel J;Yopp A;Waljee AK;Singal AG
肝硬化患者建议监测肝细胞癌（HCC）;然而，早期发现的努力受到次优效果的限制。为了推导和验证一个模型，以准确区分有和没有HCC的前列腺癌患者，并比较模型的准确性，AFP单独我们进行了一项病例对照研究，在2005年1月和2012年6月之间，在一个大型城市医院系统中看到的有和没有HCC的前列腺癌患者。我们推导了HCC和早期HCC的多变量logistic回归模型。使用10倍交叉验证方法，在推导和验证队列中使用受试者工作特征曲线分析评价鉴别能力。我们确定了1356例肝硬化患者，有（n=455; 147例早期）和无（n=901）HCC。我们发现AFP > 20 ng/mL和纤维化的非侵袭性标志物FIB-4与HCC的存在显著相关（OR 10.5，95%CI 7.9-13.9和OR 1.05，95%CI 1.03-1.07）和早期HCC（OR 4.4，95%CI 2.9-6.5和OR 1.06，95%CI 1.03-1.09）。模型纳入AFP和FIB-4有良好的区分能力，与c-统计量约为0.80，在推导和验证队列。在推导和验证队列中（分别为p=0.02和p=0.15），早期HCC模型的区分能力高于单独AFP（c-统计量0.73，95%CI 0.69-0.78）。包括AFP和FIB-4的模型可以准确地区分患有早期HCC的患者和没有HCC的患者。
Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis; however, early detection efforts are limited by suboptimal effectiveness. To derive and validate a model to accurately distinguish cirrhotic patients with and without HCC and compare the accuracy of the model to that of AFP alone We conducted a case-control study of cirrhotic patients with and without HCC seen at a large urban hospital system between January 2005 and June 2012. We derived multivariate logistic regression models for the presence of HCC and early stage HCC. Discriminatory power was evaluated using receiver operating characteristic curve analysis in derivation and validation cohorts using a 10-fold cross-validation approach. We identified 1356 patients with cirrhosis, with (n=455; 147 early stage) and without (n=901) HCC. We found AFP >20ng/mL and FIB-4, a non-invasive marker of fibrosis, were significantly associated with the presence of HCC (OR 10.5, 95%CI 7.9-13.9 and OR 1.05, 95%CI 1.03-1.07 respectively) and early stage HCC (OR 4.4, 95%CI 2.9-6.5 and OR 1.06, 95%CI 1.03-1.09 respectively). Models incorporating AFP and FIB-4 had good discriminatory power, with c-statistics of approximately 0.80, in both derivation and validation cohorts. The model for early stage HCC had higher discriminatory power than AFP alone (c-statistic 0.73, 95%CI 0.69-0.78) in derivation and validation cohorts (p=0.02 and p=0.15 respectively). Models including AFP and FIB-4 can accurately discriminate cirrhotic patients with early stage HCC from those without HCC.