<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452025000300011</article-id>
<article-id pub-id-type="doi">10.1159/000540700</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Prediction of Hepatocellular Carcinoma in a Portuguese Population after Hepatitis C Cure: Comparative Accuracy of Noninvasive Tests (Transient Elastography, FIB-4, and aMAP)]]></article-title>
<article-title xml:lang="pt"><![CDATA[Predição de Carcinoma Hepatocelular numa População Portuguesa após Cura de Hepatite C: Comparação da Precisão de Testes Não Invasivos (Elastogra&#64257;a Hepática Transitória, FIB-4, e aMAP)]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mascarenhas]]></surname>
<given-names><![CDATA[André]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Serrazina]]></surname>
<given-names><![CDATA[Juliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bronze]]></surname>
<given-names><![CDATA[Sérgio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cortez-Pinto]]></surname>
<given-names><![CDATA[Helena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Presa]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barreira]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carrola]]></surname>
<given-names><![CDATA[Paulo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vara-Luiz]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rosu-Pires]]></surname>
<given-names><![CDATA[Alexandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[Pedro Lages]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Prata]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Revés]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bravo]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nascimento]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gouveia]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Franco]]></surname>
<given-names><![CDATA[Ana Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lima]]></surname>
<given-names><![CDATA[Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[O&#8217;Neill]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mendes]]></surname>
<given-names><![CDATA[Raquel R.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Simão]]></surname>
<given-names><![CDATA[Inês Rodrigues]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[Inês Costa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gonçalves]]></surname>
<given-names><![CDATA[André Ruge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barreiro]]></surname>
<given-names><![CDATA[Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A0"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mendo]]></surname>
<given-names><![CDATA[Rui]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barosa]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A1"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Unidade Local de Saúde Lisboa Ocidental Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Unidade Local de Saúde Santa Maria Department of Gastroenterology and Hepatology ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Unidade Local de Saúde Trás-os-Montes e Alto Douro Department of Internal Medicine ]]></institution>
<addr-line><![CDATA[Vila Real ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Unidade Local de Saúde de Almada-Seixal Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Almada ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Egas Moniz School of Health and Science Egas Moniz Center for Interdisciplinary Research (CiiEM) Aging Lab]]></institution>
<addr-line><![CDATA[Almada ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Unidade Local de Saúde São José Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Unidade Local de Saúde de Loures-Odivelas Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Loures ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af8">
<institution><![CDATA[,Unidade Local de Saúde da Arrábida Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Setúbal ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af9">
<institution><![CDATA[,Unidade Local de Saúde da Região de Leiria Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Leiria ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="A10">
<institution><![CDATA[,Hospital Lusíadas Lisboa Advanced Endoscopy Center ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="A11">
<institution><![CDATA[,Hospital da Luz Lisboa Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2025</year>
</pub-date>
<volume>32</volume>
<numero>3</numero>
<fpage>11</fpage>
<lpage>23</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452025000300011&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452025000300011&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452025000300011&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Chronic infection with hepatitis C virus (HCV) causes 25% of hepatocellular carcinoma (HCC) cases worldwide, a major cause of morbimortality even after sustained virologic response (SVR). Universal screening to all patients with advanced liver &#64257;brosis is currently recommended. A risk-based strategy could improve the detection rate of early HCC and diminish the surveillance burden. Although several risk prediction models exist, exclusion of a subgroup of patients from surveillance has not yet been recommended. The objective of this study was the comparison of the predictive accuracy of transient elastography, FIB-4, and aMAP for HCC in HCV patients after SVR in Portugal.  Methods:  This was a multicentric retrospective study including patients with HCV after SVR. Comparative, univariate, multivariate, area under the ROC (receiver-operating characteristic) curve (AUC), and Youden&#8217;s J-statistic analysis were performed.  Results:  HCC incidence was 4.2% (1.3/100 patient-years) after a median follow-up of 31 months with inclusion of 337 patients. All patients had a liver stiffness measurement (LSM) before SVR (considered the baseline), but only 148 (43.9%) had a transient elastography after SVR. FIB-4 and aMAP post-SVR were calculated in all patients. Multiple parameters positively correlated with HCC, but only age and baseline transient elastography remained as independent predictors in the multivariate analysis. The optimal cutoffs for prediction of HCC were baseline transient elastography 13.7 kPa, post-SVR transient elastography 16.5 and 15.8 kPa (&#64257;rst and last measurements, respectively), FIB-4 1.6, and aMAP 58. Baseline transient elastography revealed a fair accuracy in predicting HCC (AUC 0.776, p &lt; 0.001), with the cutoff of 13.7 kPa presenting a sensitivity of 85% and a speci&#64257;city of 69%. Regarding patients who were F3-4at baseline (n = 162), almost one-third had a baseline LSM &#8804;13.7 kPa (n = 51, 31.5%), an FIB-4 &#8804;1.6 (n = 50, 30.9%), and an aMAP score &#8804;58 (n = 48, 29.6%), and these cutoffs presented an NPV of 98%, 94%, and 96%, respectively, when considering HCC development.  Conclusion:  Transient elastography (FibroScan) before SVR was a fair predictor of HCC, being more accurate than FIB-4 and aMAP. Transient elastography values &#8804;13.7 kPa at baseline, FIB-4 &#8804;1.6 and aMAP &#8804;58 were the cutoffs considered of low risk for HCC in a Portuguese cohort of HCV patients after SVR with advanced &#64257;brosis. aMAP score is a risk-based surveillance tool that could improve the current HCC screening strategy, but further validation is needed.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A infeção crónica pelo vírus da hepatite C (VHC) causa 25% dos casos de carcinoma hepatocelular (CHC) em todo o mundo, uma causa major de morbimortalidade mesmo após a resposta virológica sustentada (RVS). Um rastreio universal a todos os doentes com &#64257;brose hepática avançada é atualmente recomendado. Uma estratégia com base no risco poderia melhorar a taxa de deteção do CHC precoce e diminuir a carga do rastreio. Apesar de existirem diversos modelos de predição de risco, a exclusão de um subgrupo de doentes do rastreio ainda não foi recomendada. O objetivo deste estudo foi a comparação da capacidade preditiva da elastogra&#64257;ahepática transitória, FIB-4, e aMAP de CHC em doentes com infeção VHC após atingimento de RVS em Portugal.  Métodos:  Estudo multicêntrico retrospetivo que incluiu doentes com VHC após RVS. Foram realizadas análises comparativa, univariada, multivariada, área sob a curva ROC (AUC), e estatística J de Youden.  Resultados:  A incidência de CHC foi 4.2% (1.3/100 doente-anos) após um seguimento mediano de 31 meses com inclusão de 337 doentes. Todos os doentes incluídos apresentavam uma medição da rigidez hepática antes do atingimento da RVS (considerada a medição basal), mas a elastogra&#64257;a hepática transitória apenas foi repetida após a RVS em 148 doentes (43.9%). Os valores do FIB-4 e do aMAP no contexto pós-RVS foram possíveis de calcular em todos os doentes. Múltiplos parâmetros correlacionaram-se positivamente com o CHC, mas apenas a idade e a elastogra&#64257;a hepática transitória basal permaneceram como preditores independentes na análise multivariada. Os limiares ótimos para predição de CHC foram elastogra&#64257;a hepática transitória basal 13.7k Pa, elastogra&#64257;a hepática transitória basal pós-RVS 16.5 e 15.8 kPa (primeira e última medição, respetivamente), FIB-4 1.6 e aMAP 58. A elastogra&#64257;a hepática transitória revelou uma precisão razoável na predição de CHC (AUC 0.776, p &lt; 0.001), com o limiar de 13.7 kPa a apresentar sensibilidade de 85% e especi&#64257;cidade de 69%. Relativamente aos doentes F3-F4 antes da RVS (n = 162), praticamente um terço apresentava uma elastogra&#64257;a hepática transitória basal &#8804;13.7 kPa (n = 51, 31.5%), score FIB-4 &#8804;1.6 (n =50, 30.9%), e score aMAP &#8804;58 (n = 48, 29.6%), e estes limiares apresentaram um VPN de 98%, 94% e 96%, respetivamente, relativamente ao desenvolvimento de CHC.  Conclusão:  A elastogra&#64257;a hepática transitória (FibroScan) pré-RVS foi um preditor razoável de CHC, sendo mais preciso que o FIB-4 e o aMAP. Valores basais de elastogra&#64257;a hepática transitória &#8804;13.7 kPa, FIB-4 &#8804;1.6, e aMAP &#8804;58 foram os limiares considerados de baixo risco para CHC numa coorte de doentes Portugueses com VHC após RVS com &#64257;brose avançada. O score aMAP é uma ferramenta de rastreio de CHC baseada no risco que poderá melhorar a estratégia atual, mas é necessária validação adicional.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Chronic hepatitis C]]></kwd>
<kwd lng="en"><![CDATA[Hepatocellular carcinoma]]></kwd>
<kwd lng="en"><![CDATA[Risk assessment]]></kwd>
<kwd lng="en"><![CDATA[Screening]]></kwd>
<kwd lng="en"><![CDATA[Sustained virologic response]]></kwd>
<kwd lng="pt"><![CDATA[Avaliação de risco]]></kwd>
<kwd lng="pt"><![CDATA[Carcinoma hepatocelular]]></kwd>
<kwd lng="pt"><![CDATA[Hepatite C crónica]]></kwd>
<kwd lng="pt"><![CDATA[Rastreio]]></kwd>
<kwd lng="pt"><![CDATA[Resposta virológica sustentada]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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