Backgrounds and Aims
There is no consensus on screening for high-risk esophageal varices (HRV) in patients
with hepatocellular carcinoma (HCC). Here, we aimed to investigate the prevalence
and risk factors of HRV in patients with HCC and to assess the combination of albumin-bilirubin
grade and platelet count (ALBI-PLT score) for predicting compensated patients who
do not need unnecessary endoscopic screening for HRV.
Methods
The ALBI-PLT score was calculated by adding the ALBI grade and points for platelet
count (1 point if platelet count >150,000/mm3 and 2 points if ≤150,000/mm3). The predictive value of the ALBI-PLT score for HRV was analyzed in 887 compensated
patients enrolled from October 2007 to April 2014 (study cohort). This was validated
in 215 compensated patients from May 2014 to December 2015 (validation cohort).
Results
In the study cohort, the rates of HRV were 2.9% and 21.1% in compensated HCC patients
with an ALBI-PLT score of 2 and >2, respectively. The negative predictive values of
the ALBI-PLT score for predicting HRV were 97.1% and 98.1% in the study and validation
cohorts, respectively. For compensated patients who did not receive endoscopic screening
at the time of HCC diagnosis, the 5-year cumulative variceal hemorrhage rate was lower
in patients with an ALBI-PLT score of 2 than in those with an ALBI-PLT score >2 (1.7%
vs 9.1%, P = .007).
Conclusion
In patients with HCC with compensated liver function, an ALBI-PLT score of 2 predicted
a very low risk of HRV and variceal hemorrhage; therefore, endoscopic screening for
esophageal varices is not recommended for these patients.
Abbreviation:
ALBI (albumin-bilirubin), ALBI-PLT score (albumin-bilirubin grade and platelet count), BCLC (Barcelona Clinic Liver Cancer), CTP (Child-Turcotte-Pugh), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), HCV (hepatitis C virus), HRV (high-risk esophageal varices), HVPG (hepatic venous pressure gradient), NPV (negative predictive value), PPV (positive predictive value)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma.J Hepatol. 2016; 64: 79-86
- Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis.Hepatology. 2015; 61: 526-536
- The impact of esophagogastric varices on the prognosis of patients with hepatocellular carcinoma.Sci Rep. 2017; 7: 42577
- Outcomes of patients with hepatocellular carcinoma presenting with variceal bleeding.Am J Gastroenterol. 2004; 99: 2158-2165
- Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma.Gastroenterology. 2016; 150: 835-853
- Diagnosing and monitoring cirrhosis: liver biopsy, hepatic venous pressure gradient and elastography.Gastroenterol Hepatol. 2012; 35: 488-495
- Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.J Hepatol. 2006; 44: 217-231
- Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension.J Hepatol. 2010; 53: 762-768
- Hepatitis B and hepatocellular carcinoma.Hepatology. 2009; 49: S56-S60
- The influence of hepatitis B viral load and pre-S deletion mutations on post-operative recurrence of hepatocellular carcinoma and the tertiary preventive effects by anti-viral therapy.PLoS One. 2013; 8: e66457
- A comparison of prognosis between patients with hepatitis B and C virus-related hepatocellular carcinoma undergoing resection surgery.World J Surg. 2011; 35: 858-867
- Impact of steatosis on prognosis of patients with early-stage hepatocellular carcinoma after hepatic resection.Ann Surg Oncol. 2015; 22: 2253-2261
- Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis.Gastroenterology. 2013; 144 (e1): 102-111
- Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices.Liver Int. 2016; 36: 240-245
- Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension.J Hepatol. 2015; 63: 743-752
- A beginning or the end? A meta-analysis to assess the diagnostic accuracy of transient elastography for the prediction of esophageal varices.Saudi J Gastroenterol. 2016; 22: 345-352
- Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade.J Clin Oncol. 2015; 33: 550-558
- The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma.J Hepatol. 2017; 66: 338-346
- Incorporating albumin-bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma.J Gastroenterol Hepatol. 2017; 32: 221-228
- Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion.Br J Cancer. 2017; 116: 448-454
- The albumin-bilirubin grade improves hepatic reserve estimation post-sorafenib failure: implications for drug development.Aliment Pharmacol Ther. 2017; 45: 714-722
- Management of hepatocellular carcinoma.Hepatology. 2005; 42: 1208-1236
- American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update.Hepatology. 2011; 53: 1020-1022
- Prognosis of early-stage hepatocellular carcinoma: the clinical implications of substages of Barcelona Clinic Liver Cancer system based on a cohort of 1265 patients.Medicine (Baltimore). 2015; 94: e1929
- Prediction of variceal hemorrhage by esophageal endoscopy.Gastrointest Endosc. 1981; 27: 213-218
- Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.Hepatology. 2007; 46: 922-938
- The treatment of portal hypertension: a meta-analytic review.Hepatology. 1995; 22: 332-354
- Prevalence and prognostic significance of the presence of esophageal varices in patients with hepatocellular carcinoma.Clin Gastroenterol Hepatol. 2006; 4: 1378-1384
- Progressive accumulation of mutations in the hepatitis B virus genome and its impact on time to diagnosis of hepatocellular carcinoma.Hepatology. 2016; 64: 720-731
- Liver cancer: approaching a personalized care.J Hepatol. 2015; 62: S144-S156
- Noninvasive assessment of portal hypertension in patients with cirrhosis.Hepatology. 2011; 53: 683-694
- Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers.Eur J Gastroenterol Hepatol. 2011; 23: 754-758
- Spleen stiffness in patients with cirrhosis in predicting esophageal varices.Am J Gastroenterol. 2013; 108: 1101-1107
- Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study.J Hepatol. 2011; 55: 1017-1024
- Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging.J Hepatol. 2016; 65: 1131-1139
- Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices.J Hepatol. 2016; 65: 899-905
- Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy.J Hepatol. 2011; 54: 650-659
- Identifying compensated advanced chronic liver disease: when (not) to start screening for varices and clinically significant portal hypertension.in: de Franchis R. Portal Hypertension VI: Proceedings of the Sixth Baveno Consensus Workshop: stratifying risk and individualizing care. Springer, Cham, Switzerland2016: 30-49
Article info
Publication history
Published online: January 06, 2018
Accepted:
December 3,
2017
Received:
August 3,
2017
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Screening for esophageal varices in patients with hepatocellular carcinomaGastrointestinal EndoscopyVol. 88Issue 2
- PreviewEsophageal varices are identified in 10% to 40% of all patients with cirrhosis. Generally, they are most likely to be large and high risk in patients with advanced liver disease. Furthermore, the more severe portal hypertension is, the more likely are large varices to present. Several specific tests and systems have been developed with which to predict large varices, high-risk varices, or both. For example, platelet count, various blood tests and markers, spleen size, liver stiffness, spleen stiffness, and other measures have all been used.
- Full-Text
- Preview
