UCLA Department of Medicine, Los Angeles, CA, USA.
Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, USA.
Dig Dis Sci. 2024 Aug;69(8):3079-3084. doi: 10.1007/s10620-024-08449-y. Epub 2024 Jun 19.
Treatment with atezolizumab and bevacizumab has become standard of care for advanced unresectable hepatocellular carcinoma (HCC) but carries an increased gastrointestinal bleeding risk. Therefore, patients are often required to undergo esophagogastroduodenoscopy (EGD) to rule out esophageal varices (EV) prior to initiating therapy, which can delay care and lead to unnecessary procedural risks and health care costs. In 2019, the EVendo score was created and validated as a noninvasive tool to accurately screen out patients who were at low risk for having EV that required treatment. We sought to validate whether the EVendo score could be used to accurately predict the presence of EV and varices needing treatment (VNT) in patients with HCC.
This was a retrospective multicenter cohort study of patients with HCC from 9/2004 to 12/2021. We included patients who underwent EGDs within 1 year after their HCC diagnosis. We collected clinical parameters needed to calculate an EVendo score at the time of EGD and compared the EVendo model prediction to the gold standard endoscopic report in predicting presence of VNT.
112 with HCC were recruited to this study, with 117 qualifying EGDs. VNT occurred in 39 (33.3%) patients. The EVendo score had a sensitivity of 97.4% and a negative predictive value of 96.9%, supporting the validity in applying EVendo in predicting VNT in HCC.
In this study, we validated the use of the EVendo score in ruling out VNT in patients with HCC. The application of the EVendo score could safely defer about 30% of EGDs for EV screening in HCC patients. Although additional validation cohorts are needed, this suggests that EVendo score can potentially be applied in patients with HCC to avoid unnecessary EGDs, which can ultimately mitigate healthcare costs and delays in initiating HCC treatment with atezolizumab and bevacizumab.
阿特珠单抗和贝伐珠单抗联合治疗已成为不可切除的晚期肝细胞癌（HCC）的标准治疗方法，但会增加胃肠道出血的风险。因此，在开始治疗前，患者通常需要进行食管胃十二指肠镜检查（EGD）以排除食管静脉曲张（EV），这可能会延迟治疗，并导致不必要的程序风险和医疗保健费用。2019 年，EVendo 评分被创建并验证为一种非侵入性工具，可准确筛选出需要治疗的 EV 风险较低的患者。我们试图验证 EVendo 评分是否可用于准确预测 HCC 患者 EV 的存在和需要治疗的静脉曲张（VNT）。
这是一项回顾性多中心 HCC 患者队列研究，纳入 2004 年 9 月至 2021 年 12 月期间的 HCC 患者。我们纳入了在 HCC 诊断后 1 年内接受 EGD 检查的患者。我们收集了 EGD 时计算 EVendo 评分所需的临床参数，并将 EVendo 模型预测与金标准内镜报告进行比较，以预测 VNT 的存在。
本研究共纳入 112 例 HCC 患者，共 117 例 EGD 检查符合条件。39 例（33.3%）患者发生 VNT。EVendo 评分的敏感性为 97.4%，阴性预测值为 96.9%，支持 EVendo 在预测 HCC 中 VNT 的有效性。
在这项研究中，我们验证了 EVendo 评分在排除 HCC 患者 VNT 中的应用。EVendo 评分的应用可安全地避免约 30%的 HCC 患者进行 EV 筛查的 EGD。尽管需要更多的验证队列，但这表明 EVendo 评分可潜在地应用于 HCC 患者，以避免不必要的 EGD，从而最终减轻医疗保健费用并延迟使用阿特珠单抗和贝伐珠单抗治疗 HCC。
