SC Connecticut News

Hepatocellular carcinoma, a prevalent type of liver cancer, remains a significant health challenge worldwide. Traditionally, screening efforts have focused on individuals with viral hepatitis or cirrhosis. However, increasing obesity rates have introduced metabolic dysfunction-associated steatotic liver disease (MASLD) as another major risk factor not yet incorporated into existing screening practices.

Researchers from Yale and the University of Pennsylvania have addressed this gap by developing a new risk score for hepatocellular carcinoma that considers these factors. Their study, titled “Risk Score for Hepatocellular Cancer in Adults Without Viral Hepatitis or Cirrhosis,” was published in JAMA Network Open on November 6, 2024.

Tamar Taddei, MD, professor of medicine at Yale and one of the principal investigators, highlighted the evolving landscape of liver cancer detection: “Now that we can better treat viral liver diseases, we’re increasingly observing hepatocellular carcinoma in patients with MASLD. This condition is harder to detect, and we’re seeing liver cancer emerge in these patients even before cirrhosis develops. We want to understand the liver cancer risk in these populations.”

The research involved a cohort study using data from over six million adults within the Veterans Health Administration (VA). The study excluded individuals with known hepatitis B or C infections or decompensated cirrhosis. Data collected included demographics and health indicators such as age, sex, race, body mass index (BMI), FIB-4 index for liver fibrosis estimation, diabetes status, smoking habits, and alcohol use. Out of 6,508,288 participants studied from 2007 to 2020, 15,142 developed hepatocellular carcinoma.

Janet Tate MPH ScD explained how their findings challenge conventional wisdom: “Conventional wisdom has been that you have to have a FIB-4 greater than 3.25 to be considered at high risk but our work refutes this. Most of our hepatocellular carcinoma cases were in people who had FIB-4 lower than that.”

Their analysis broke down FIB-4 into its components—AST ALT platelets and age—and used continuous variables instead of categorical ones to enhance predictive accuracy. Tate encourages others: “I would encourage other statisticians or epidemiologists to not be afraid of continuous variables... there’s a loss of information.”

The researchers aim for their risk score to exemplify precision medicine by calculating cumulative effects rather than focusing on individual factors alone: “This work puts all the risk factors together coming up with a single score from zero to one hundred,” said Tate.

Amy Justice MD PhD hopes this research will aid patients’ understanding: “Factors such as smoking and obesity not only contribute to cardiovascular disease but also to liver disease... Recognition and modification... is essential.”

The authors are working toward validating their model outside VA settings due partly due perceived limitations specific veteran population contexts which may affect generalizability according Dr Justice based her experience similar endeavors related HIV-related predictive modeling collaborations broader cohorts consistently showed applicability beyond VA context

Dr Taddei expressed confidence clinical utility saying “This clinical score provides primary care clinicians straightforward tool assess whether concerned about liver cancer”

In addition core team contributing members included Ysabel Ilagan-Ying Kirsha Gordon Joseph Lim Jessie Torgersen Vincent Lo Re III among others representing both Yale University Pennsylvania Perelman School Medicine

To learn more readers directed read full paper referenced article

Since forming one nation first sections hepatology gastroenterology over fifty years ago Yale Section Digestive Diseases continued impactful contributions field gastrointestinal disorders further details available via online resource link provided original document