Dana J, Meyer A, Paisant A, Rode A, Sartoris R, Séror O, Cassinotto C, Milot L, Grégory J, Cœur J, Lebigot J, Schembri V, Villeret F, Takeda AN, Ronot M, Vilgrain V, Baumert TF, Gallix B, Padoy N, Nahon P.
JHEP Rep. 2025 Jul 5;7(10):101510.
Background & aims: Hepatocellular carcinoma (HCC) surveillance programs are suboptimal. We aimed to design an ultrasound-based deep learning model for HCC risk stratification (STARHE-RISK) and early-stage HCC detection (STARHE-DETECT) in patients with compensated advanced chronic liver disease (cACLD).
Methods: This prospective multicentric study included 403 adult patients with cACLD of all causes enrolled in a surveillance program for at least 6 months without prior history of HCC. STARHE-RISK was trained on ultrasound cine clips of the non-tumoral liver parenchyma using two classes: cases (n = 152 patients with early-stage HCC; 137/152 [82%] male; median age 63 years) and controls (n = 170 patients without HCC at inclusion and during a subsequent 1-year follow-up; 120/170 [71%] male; median age 69 years). STARHE-DETECT was trained on tumour ultrasound cine clips. The training/validation and testing sets were stratified according to potential confounders, and 50 patients who were balanced in both groups were allocated to the independent testing set based on sample size calculation. Statistical analysis included classification and detection metrics.
Results: STARHE-RISK achieved good prediction performances in the testing set with a 0.72 accuracy (95% CI 0.57-0.84) and an odds ratio of 6.6 (95% CI 1.9-22.7; p = 0.003). The combination of STARHE-RISK and the FASTRAK score, a multi-aetiology HCC risk stratification score, achieved a higher specificity (0.86 [95% CI 0.65-0.97]) and odds ratio (8.9 [95% CI 2.1-38.3; p = 0.004]) for predicting a patient at high risk of HCC development. STARHE-DETECT achieved a 0.67 mAP10, a 0.68 sensitivity (95% CI 0.47-0.85), and a 0.82 specificity (95% CI 0.69-0.91) for detecting early-stage HCC.
Conclusions: STARHE-RISK and STARHE-DETECT achieved robust performances for HCC risk stratification and early-stage HCC detection, respectively. They could become valuable surveillance tools and pave the way for a risk-based personalised surveillance program.
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