Backgrounds and Aims

There is no consensus on screening for high-risk esophageal varices (HRV) in patients with hepatocellular carcinoma (HCC). Here, we aimed to investigate the prevalence and risk factors of HRV in patients with HCC and to assess the combination of albumin-bilirubin grade and platelet count (ALBI-PLT score) for predicting compensated patients who do not need unnecessary endoscopic screening for HRV.

Methods

The ALBI-PLT score was calculated by adding the ALBI grade and points for platelet count (1 point if platelet count >150,000/mm³ and 2 points if ≤150,000/mm³). The predictive value of the ALBI-PLT score for HRV was analyzed in 887 compensated patients enrolled from October 2007 to April 2014 (study cohort). This was validated in 215 compensated patients from May 2014 to December 2015 (validation cohort).

Results

In the study cohort, the rates of HRV were 2.9% and 21.1% in compensated HCC patients with an ALBI-PLT score of 2 and >2, respectively. The negative predictive values of the ALBI-PLT score for predicting HRV were 97.1% and 98.1% in the study and validation cohorts, respectively. For compensated patients who did not receive endoscopic screening at the time of HCC diagnosis, the 5-year cumulative variceal hemorrhage rate was lower in patients with an ALBI-PLT score of 2 than in those with an ALBI-PLT score >2 (1.7% vs 9.1%, P = .007).

Conclusion

In patients with HCC with compensated liver function, an ALBI-PLT score of 2 predicted a very low risk of HRV and variceal hemorrhage; therefore, endoscopic screening for esophageal varices is not recommended for these patients.

中文翻译：

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结合白蛋白-胆红素等级和血小板预测不需要内镜检查食管静脉曲张的代偿性肝细胞癌患者

背景和目标

对于肝细胞癌（HCC）患者高危食管静脉曲张（HRV）的筛查尚无共识。在这里，我们旨在调查HCC患者中HRV的患病率和危险因素，并评估白蛋白-胆红素等级和血小板计数（ALBI-PLT评分）的组合，以预测不需要内镜筛查HRV的代偿患者。

方法

ALBI-PLT得分是通过将ALBI等级和血小板计数点相加得出的（如果血小板计数> 150,000 / mm ³则为1分，而≤150,000/ mm ³则为2分）。分析了2007年10月至2014年4月登记的887例补偿患者的ALBI-PLT分数对HRV的预测价值（研究队列）。从2014年5月到2015年12月，这215名有补偿的患者得到了验证（验证队列）。

结果

在研究队列中，代偿性HCC患者的ALBI-PLT评分分别为2和> 2时，HRV的发生率分别为2.9％和21.1％。在研究和验证队列中，ALBI-PLT评分对HRV的阴性预测值分别为97.1％和98.1％。对于在HCC诊断时未接受内窥镜检查的代偿患者，ALBI-PLT得分为2的患者的5年累积静脉曲张出血率低于ALBI-PLT得分> 2的患者的5年累积曲张静脉出血率（1.7％ vs 9.1％，P  = .007）。

结论

在肝功能补偿的肝癌患者中，ALBI-PLT评分为2分预示着HRV和静脉曲张破裂出血的风险非常低。因此，不建议对这些患者进行内窥镜检查食管静脉曲张。