Patients with liver cirrhosis are at high risk of developing hepatocellular carcinoma (HCC) which implies significant mortality. At present current surveillance methods detect hepatocellular carcinomas at a late stage resulting in few treatment options for patients and, in the majority of cases, premature death.
The goal of this study is to implement Elecsys® GAAD in real-world hepatocellular carcinoma surveillance for those with liver cirrhosis.
The main questions it aims to answer are:
* Does the introduction of the Elecsys® GAAD algorithm to the surveillance pathway increase early detection of HCC? * Does the introduction of the Elecsys® GAAD algorithm to the surveillance pathway reduce false positive tests and unnecessary confirmatory investigations? * Does the new surveillance pathway improve adherence?
Researchers will compare Elecsys® GAAD with standard of care tests to see if it results in earlier detection of hepatocellular carcinoma and will explore potential improvements to the surveillance pathway.
None
Pregnancy/breast-feeding.
Patients who do not have liver cirrhosis
Patients who already have hepatocellular carcinoma
Any patient who is unable to understand, retain and weigh information to make an informed decision, will be excluded from the study. The investigators will use every opportunity, including tele-interpretation services to minimise this from happening.
Single group
Elecsys® GAAD
Diagnostic testElecsys® GAAD is a CE marked in vitro diagnostic (IVD) multivariate index assay, intended as an aid in the diagnosis of early-stage HCC. It provides a semi quantitative result by combining in an algorithm the quantitative measurements of Elecsys® AFP (alpha-fetoprotein) and Elecsys® PIVKA-II (protein induced by vitamin K absence II) levels in serum and plasma, with gender and age. Clinical evidence showed that Elecsys® GAAD had high performance in detecting HCC (sensitivity 86.5%), particularly early stage (sensitivity 78.9%), with 91.4% specificity for both early and all stages, out-performing current standard of care (Chan et al. 2021). Elecsys® GAAD may be integrated into current surveillance practice to increase early-stage HCC detection rate, reduce unnecessary onward investigations and patient anxiety.
Incidence of hepatocellular carcinoma diagnosis
Incidence recorded as number of cases per study cohort
Stage of hepatocellular carcinoma at diagnosis
Barcelona Clinic Liver Cancer (BCLC) stage 0-D
Rates of false positives for each combination of diagnostic tests
Count (%) of True/False positives for each test (against magnetic resonance imaging (MRI) / computerised tomography (CT)) will be reported. Results from different tests (and their (meaningful) combination) will be tabulated against each other: * Alpha-fetoprotein (AFP) vs GAAD * Ultrasound scan (USS) vs GAAD * AFP+ USS vs GAAD * AFP+USS vs GAAD +USS * AFP/GAAD/USS/AFP+USS/GAAD+USS vs MRI/CT for those who proceed to confirmatory imaging.
Rates of curative treatment
Rates of curative treatment being offered (%) will be recorded on an intention to treat (ITT) basis from Multi-Disciplinary Team (MDT) meeting outcomes.
Rates of adherence
• Attendance rates for biannual surveillance appointments (%), within predefined tolerance of 5-9 months post previous appointment.
Rates of discontinuation
• Count (%) of surveillance discontinuation, defined as no visit \>12 months.
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Manchester University NHS Foundation Trust
Lead sponsor
University of Manchester
Collaborator
Roche Pharma AG
Collaborator
Unity Insights
Collaborator
Imperial College London
Collaborator
