Advertisement

Medical Oncology

, 36:26 | Cite as

Population-based assessment of the national comprehensive cancer network recommendations for baseline imaging of hepatocellular carcinoma

  • Omar Abdel-Rahman
  • Winson Y. CheungEmail author
Original Paper
  • 12 Downloads

Abstract

This analysis aims to evaluate the performance characteristics of alternative baseline imaging thresholds in a cohort of hepatocellular carcinoma (HCC) patients from the Surveillance, Epidemiology, and End Results (SEER) database. HCC patients within the SEER database (2010–2015) who had complete information on clinical T and N stages as well as complete information on metastatic sites were eligible for the current study. Various performance characteristics associated with baseline imaging were investigated, including specificity, sensitivity, positive likelihood ratio (LR), negative LR, number needed to investigate (NNI), negative predictive value (NPV), positive predictive value (PPV), and accuracy. A total of 27,201 HCC patients were included. Based on current recommendations that advocate for the use of cross-sectional chest imaging in all newly diagnosed cases of HCC, these recommendations would yield a PPV of 5.0% for the detection of lung metastases. This would translate to an NNI of 20.0. When T1N0 patients were excluded from routine chest or bone imaging, this resulted in a PPV of 6.8% for the identification of lung metastases and an NNI of 14.7. Likewise, this translated to a PPV of 4.6% for the identification of bone metastases and an NNI of 21.7. Similarly, when patients with T1N0 disease and normal alpha-fetoprotein (AFP) were excluded from routine imaging, this resulted in a PPV of 5.6% for the identification of lung metastases and an NNI of 17.8. Also, this translated to a PPV of 3.8% for the identification of bone metastases and an NNI of 26.3. The current study suggests that the omission of routine baseline chest imaging may be considered in selected patients with asymptomatic early-stage HCC and normal AFP.

Keywords

HCC Staging NCCN Staging Prognosis 

Notes

Funding

This study was not funded.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the author.

Informed consent

As this study is based on a publicly available database without identifying patient information, informed consent was not needed.

References

  1. 1.
    Verslype C, Rosmorduc O, Rougier P. Hepatocellular carcinoma: ESMO-ESDO Clinical Practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii41–8.CrossRefGoogle Scholar
  2. 2.
    Oweira H, Petrausch U, Helbling D, Schmidt J, Mehrabi A, Schob O, et al. Prognostic value of site-specific extra-hepatic disease in hepatocellular carcinoma: a SEER database analysis. Expert Rev Gastroenterol Hepatol. 2017;11:1–7.Google Scholar
  3. 3.
  4. 4.
  5. 5.
    Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.CrossRefGoogle Scholar
  6. 6.
    Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017;3(4):524–48.CrossRefGoogle Scholar
  7. 7.
    Abdel-Rahman O. Assessment of the discriminating value of the 8th AJCC stage grouping for hepatocellular carcinoma. HPB (Oxford). 2018;20(1):41–8.CrossRefGoogle Scholar
  8. 8.
    Surveillance, Epidemiology and End Results Program. About the SEER Program. http://seer.cancer.gov/about. Accessed 25 June 2016.
  9. 9.
    Jin YJ, Lee HC, Lee D, Shim JH, Kim KM, Lim YS, et al. Role of the routine use of chest computed tomography and bone scan in staging workup of hepatocellular carcinoma. J Hepatol. 2012;56(6):1324–9.CrossRefGoogle Scholar
  10. 10.
    Deek H, Newton P, Sheerin N, Noureddine S, Davidson PM. Contrast media induced nephropathy: a literature review of the available evidence and recommendations for practice. Aust Crit Care. 2014;27(4):166–71.CrossRefGoogle Scholar
  11. 11.
    Ziegler L, Hill K, Neilly L, Bennett MI, Higginson IJ, Murray SA, et al. Identifying psychological distress at key stages of the cancer illness trajectory: a systematic review of validated self-report measures. J Pain Symptom Manage. 2011;41(3):619–36.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical Oncology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Department of OncologyUniversity of Calgary, Tom Baker Cancer CentreCalgaryCanada

Personalised recommendations