Background/Aims A large percentage of patients undergoing esophagogastroduodenoscopy (EGD) screening do not have esophageal varices (EV) or have only small EV. We evaluated a large, international, multicenter cohort to develop a novel score, termed FIB-4plus, by combining the fibrosis-4 (FIB-4) score, liver stiffness measurement (LSM), and spleen stiffness measurement (SSM) to identify high-risk EV (HRV) in compensated cirrhosis.
Methods This international cohort study involved patients with compensated cirrhosis from 17 Chinese hospitals and one Croatian institution (NCT04546360). Two-dimensional shear wave elastography-derived LSM and SSM values, and components of the FIB-4 score (i.e., age, aspartate aminotransferase, alanine aminotransferase, and platelet count [PLT]) were combined using machine learning algorithms (logistic regression [LR] and extreme gradient boosting [XGBoost]) to develop the LR-FIB-4plus and XGBoost-FIB-4plus models, respectively. Shapley Additive exPlanations method was used to interpret the model predictions.
Results We analyzed data from 502 patients with compensated cirrhosis who underwent EGD screening. The XGBoost-FIB-4plus score demonstrated superior predictive performance for HRV, with an area under the receiver operating characteristic curve (AUROC) of 0.927 (95% confidence interval [CI] 0.897–0.957) in the training cohort (n=268), and 0.919 (95% CI 0.843–0.995) and 0.902 (95% CI 0.820–0.984) in the first (n=118) and second (n=82) external validation cohorts, respectively. Additionally, the XGBoost-FIB-4plus score exhibited high AUROC values for predicting EV across all cohorts. The FIB-4plus score outperformed the individual parameters (LSM, SSM, PLT, and FIB-4).
Conclusions The FIB-4plus score effectively predicted EV and HRV in patients with compensated cirrhosis, providing clinicians with a valuable tool for optimizing patient management and outcomes.
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The Modified Response Evaluation Criteria in Solid Tumors (RECIST) Yield a More Accurate Prognoses Than the RECIST 1.1 in Hepatocellular Carcinoma Treated with Transarterial Radioembolization Jae Seung Lee, Hong Jun Choi, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Song-Ee Baek, Yong Eun Chung, Mi-Suk Park, Myeong-Jin Kim, Hyungjin Rhee, Seung Up Kim Gut and Liver.2020; 14(6): 765. CrossRef
Hepatocellular Carcinoma Risk According to Regimens for Eradication of Hepatitis C Virus; Interferon or Direct Acting Antivirals Hye Won Lee, Dai Hoon Han, Hye Jung Shin, Jae Seung Lee, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Beom Kyung Kim Cancers.2020; 12(11): 3414. CrossRef
Diffusion-Weighted Magnetic Resonance Imaging in Hepatocellular Carcinoma as a Predictor of a Response to Cisplatin-Based Hepatic Arterial Infusion Chemotherapy Pil Soo Sung, Moon Hyung Choi, Hyun Yang, Soon Kyu Lee, Ho Jong Chun, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon, Joon-Il Choi, Young Joon Lee, Si Hyun Bae Frontiers in Oncology.2020;[Epub] CrossRef
Appraisal of Long-Term Outcomes of Liver-Directed Concurrent Chemoradiotherapy for Hepatocellular Carcinoma with Major Portal Vein Invasion
Sojung Han, Hye Won Lee, Jun Yong Park, Seung Up Kim, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Jinsil Seong, Jong Yun Won, Dai Hoon Han, Beom Kyung Kim Journal of Hepatocellular Carcinoma.2020; Volume 7: 403. CrossRef
A Real-World Comparative Analysis of Lenvatinib and Sorafenib as a Salvage Therapy for Transarterial Treatments in Unresectable HCC Jaejun Lee, Pil Soo Sung, Hyun Yang, Soon Kyu Lee, Hee Chul Nam, Sun Hong Yoo, Hae Lim Lee, Hee Yeon Kim, Sung Won Lee, Jung Hyun Kwon, Jeong Won Jang, Chang Wook Kim, Soon Woo Nam, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon Journal of Clinical Medicine.2020; 9(12): 4121. CrossRef
Circulating Exosomal MicroRNA-1307-5p as a Predictor for Metastasis in Patients with Hepatocellular Carcinoma Jung Woo Eun, Chul Won Seo, Geum Ok Baek, Moon Gyeong Yoon, Hye Ri Ahn, Ju A. Son, Suna Sung, Do Wan Kim, Soon Sun Kim, Hyo Jung Cho, Jae Youn Cheong Cancers.2020; 12(12): 3819. CrossRef
A New Diagnostic Criterion with Gadoxetic Acid-Enhanced MRI May Improve the Diagnostic Performance for Hepatocellular Carcinoma Yi Wei, Zheng Ye, Yuan Yuan, Zixing Huang, Xiaocheng Wei, Tong Zhang, Shang Wan, Hehan Tang, Xiaopeng He, Bin Song Liver Cancer.2020; 9(4): 414. CrossRef
Hepatocellular Carcinoma Risk Steadily Persists over Time Despite Long-Term Antiviral Therapy for Hepatitis B: A Multicenter Study Seung Up Kim, Yeon Seok Seo, Han Ah Lee, Mi Na Kim, Eun Ju Lee, Hye Jung Shin, Yu Rim Lee, Hye Won Lee, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Soon Ho Um, Won Young Tak, Young Oh Kweon, Beom Kyung Kim, Soo Young Park Cancer Epidemiology, Biomarkers & Prevention.2020; 29(4): 832. CrossRef
Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma Tunyarat Wattanasatesiri, Hyo-Cheol Kim, Jin Woo Choi, Jeong-Hoon Lee, Ijin Joo, Saebeom Hur, Myungsu Lee, Hwan Jun Jae, Jin Wook Chung Journal of Vascular and Interventional Radiology.2019; 30(8): 1273. CrossRef
LI-RADS Version 2017 versus Version 2018: Diagnosis of Hepatocellular Carcinoma on Gadoxetate Disodium–enhanced MRI Sang Min Lee, Jeong Min Lee, Su Joa Ahn, Hyo-Jin Kang, Hyun Kyung Yang, Jeong Hee Yoon Radiology.2019; 292(3): 655. CrossRef
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