Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Aug;83(8):737-742. doi: 10.1097/JCMA.0000000000000378.
The indocyanine green 15-minute retention (ICG-r15) test was considered as a noninvasive marker of esophageal varices (EV) in cirrhotic patients. However, the performance of ICG-r15 in patients with hepatocellular carcinoma (HCC) has rarely been assessed. The aim of this study is to evaluate the value of ICG-r15 as a noninvasive marker of EV in patients with HCC.
From October 2007 to December 2018, the study retrospectively enrolled 137 HCC patients with compensated hepatic function who received ICG-r15 tests and endoscopy screening for EV. The predictive value of the ICG-r15 test and other noninvasive markers was also evaluated for the diagnosis of EV, including the aspartate aminotransferase (AST)/alanine aminotransferase ratio, platelet count/spleen diameter ratio, AST/platelet ratio index, Lok index, FIB-4, and Park index.
In the study cohort, 30 (21.9%) patients had EV. The area under the receiver operating characteristic curve for determining EV by ICG-r15 was 0.784 (95% CI: 0.686-0.881, -2 ln (L): 77.889, Akaike information criterion: 79.889), and it had the best predictive value compared with other noninvasive markers. The cutoff value of ICG-r15 to identify EV was 31.0%, and it had 40.0% sensitivity and 98.1% specificity. The cutoff value to exclude EV was 9.5% with 86.7% sensitivity and 50.5% specificity. In the multivariate analysis, ICG-r15 (odds ratio [OR]: 1.062, 1.014-1.114; p = 0.015) and the Park index (OR: 1.535, 1.091-2.159; p = 0.014) were independently related to the presence of EV.
ICG-r15 is a practical noninvasive marker with cutoff values of 9.5% for excluding EV and 31.0% for identifying EV in patients with HCC.
吲哚菁绿 15 分钟滞留（ICG-r15）试验被认为是肝硬化患者食管静脉曲张（EV）的非侵入性标志物。然而，ICG-r15 在肝细胞癌（HCC）患者中的表现很少被评估。本研究旨在评估 ICG-r15 作为 HCC 患者 EV 非侵入性标志物的价值。
2007 年 10 月至 2018 年 12 月，本研究回顾性纳入 137 例肝功能代偿的 HCC 患者，他们接受了 ICG-r15 试验和 EV 内镜筛查。还评估了 ICG-r15 试验和其他非侵入性标志物对 EV 诊断的预测价值，包括天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶比值、血小板计数/脾脏直径比值、AST/血小板比值指数、Lok 指数、FIB-4 和 Park 指数。
在研究队列中，30（21.9%）例患者存在 EV。ICG-r15 用于确定 EV 的受试者工作特征曲线下面积为 0.784（95%CI：0.686-0.881，-2ln（L）：77.889，Akaike 信息准则：79.889），与其他非侵入性标志物相比，其具有最佳的预测价值。ICG-r15 识别 EV 的最佳截断值为 31.0%，其敏感性为 40.0%，特异性为 98.1%。排除 EV 的最佳截断值为 9.5%，其敏感性为 86.7%，特异性为 50.5%。在多变量分析中，ICG-r15（比值比[OR]：1.062，1.014-1.114；p = 0.015）和 Park 指数（OR：1.535，1.091-2.159；p = 0.014）与 EV 的存在独立相关。
ICG-r15 是一种实用的非侵入性标志物，其截断值为 9.5%，用于排除 EV，31.0%用于识别 HCC 患者的 EV。
