1
|
Truong TN, Pham TND, Hoang LB, Nguyen VT, Dao HV, Dao DVB, Alessy S, Pham HB, Pham TTT, Nguyen LDD, Nguyen K, Abaalkhail F, Manal M, Mawardi M, AlZahrani M, Alswat K, Alghamdi H, Sanai FM, Siddiqui MA, Nguyen NH, Vaidya D, Phan HT, Johnson PJ, Alqahtani SA, Dao DY. Surveillance and treatment of primary hepatocellular carcinoma (aka. STOP HCC): protocol for a prospective cohort study of high-risk patients for HCC using GALAD-score. BMC Cancer 2023; 23:875. [PMID: 37723439 PMCID: PMC10506187 DOI: 10.1186/s12885-023-11167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/11/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Vietnam and Saudi Arabia have high disease burden of primary hepatocellular carcinoma (HCC). Early detection in asymptomatic patients at risk for HCC is a strategy to improve survival outcomes in HCC management. GALAD score, a serum-based panel, has demonstrated promising clinical utility in HCC management. However, in order to ascertain its potential role in the surveillance of the early detection of HCC, GALAD needs to be validated prospectively for clinical surveillance of HCC (i.e., phase IV biomarker validation study). Thus, we propose to conduct a phase IV biomarker validation study to prospectively survey a cohort of patients with advanced fibrosis or compensated cirrhosis, irrespective of etiologies, using semi-annual abdominal ultrasound and GALAD score for five years. METHODS We plan to recruit a cohort of 1,600 patients, male or female, with advanced fibrosis or cirrhosis (i.e., F3 or F4) and MELD ≤ 15, in Vietnam and Saudi Arabia (n = 800 each). Individuals with a liver mass ≥ 1 cm in diameter, elevated alpha-fetoprotein (AFP) (≥ 9 ng/mL), and/or elevated GALAD score (≥ -0.63) will be scanned with dynamic contrast-enhanced magnetic resonance imaging (MRI), and a diagnosis of HCC will be made by Liver Imaging Reporting and Data System (LiRADS) assessment (LiRADS-5). Additionally, those who do not exhibit abnormal imaging findings, elevated AFP titer, and/or elevated GALAD score will obtain a dynamic contrast-enhanced MRI annually for five years to assess for HCC. Only MRI nearest to the time of GALAD score measurement, ultrasound and/or AFP evaluation will be included in the diagnostic validation analysis. MRI will be replaced with an abdominal computed tomography scan when MRI results are poor due to patient conditions such as movement etc. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI will not be carried out in study sites in both countries. Bootstrap resampling technique will be used to account for repeated measures to estimate standard errors and confidence intervals. Additionally, we will use the Cox proportional hazards regression model with covariates tailored to the hypothesis under investigation for time-to-HCC data as predicted by time-varying biomarker data. DISCUSSION The present work will evaluate the performance of GALAD score in early detection of liver cancer. Furthermore, by leveraging the prospective cohort, we will establish a biorepository of longitudinally collected biospecimens from patients with advanced fibrosis or cirrhosis to be used as a reference set for future research in early detection of HCC in the two countries. TRIAL REGISTRATION Name of the registry: ClinicalTrials.gov Registration date: 22 April 2022 Trial registration number: NCT05342350 URL of trial registry record.
Collapse
Affiliation(s)
- Thai Ngoc Truong
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Trang Ngoc Doan Pham
- School of Public Health, the University of Illinois in Chicago, Chicago, IL, USA
| | - Long Bao Hoang
- Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Van Thi Nguyen
- Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Hang Viet Dao
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
- Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | | | - Saleh Alessy
- College of Health Sciences, the Saudi Electronic University, Jeddah, Saudi Arabia
| | | | | | - Linh Duc Duy Nguyen
- Medic Medical Center in Rach Gia, Rach Gia City, Kien Giang Province, Vietnam
| | - Khue Nguyen
- Medic Medical Center in Ca Mau, Ca Mau City, Vietnam
| | - Faisal Abaalkhail
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Mohammed Manal
- Department of Internal Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohammad Mawardi
- Department of Internal Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - May AlZahrani
- Department of Internal Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Khalid Alswat
- Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Faisal M Sanai
- Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Amir Siddiqui
- Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | | | - Dhananjay Vaidya
- The BEAD Core (Biostatistics, Epidemiology, and Data Management), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hai Thanh Phan
- Medic Medical Center in Ho Chi Minh, Ho Chi Minh City, Vietnam
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Saleh A Alqahtani
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA.
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
| | - Doan Y Dao
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA.
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA.
- Center of Excellence for Liver Disease in Vietnam, Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|