Abstract P060: A case of stage II hepatocellular carcinoma diagnosed using a multi-cancer early detection test
Authors: Poliak Martin 
Published: January 2023

Abstract
Introduction: Liver cancer is the third leading cause of cancer-related deaths in the world, with liver cancer incidence and related deaths increasing in the United States. Although there is no guideline-recommending screening for liver cancer for the general population, the American Association for the Study of Liver Diseases recommends liver cancer surveillance in individuals with cirrhosis through ultrasound imaging, with or without alpha-fetoprotein (AFP) testing, every 6 months. A multi-cancer early detection (MCED) test was developed that detects a shared cancer signal from methylation patterns of cell-free DNA in blood. A ‘cancer signal detected’ result (positive result) is reported with 1 or 2 cancer signal origin (CSO) prediction(s). Here, an early-stage liver cancer case is presented to review the diagnostic pathway guided by a positive MCED test result. Case Description/Methods: A 62-year-old White male (BMI: 25.2 kg/m2) with chronic hepatitis B (low viral load since 9 years ago; no active therapy) underwent MCED testing. He reported moderate alcohol use (2-3 drinks/day) and that he formerly smoked over 10 years ago. He had a prostatectomy for prostate cancer 2 years prior to using the test. Three days after a blood sample was collected for analysis by the MCED test, computed tomography (CT) of the abdomen was performed as follow-up on a 1.9 cm indeterminate nodule without interval change for 1 year; CT of the abdomen showed a 1.9x1.9x1.9 cm left hepatic lobe nodule. Ten days after the CT scan, a positive MCED test result (top-CSO prediction=Liver/Bile duct; second-CSO prediction=Lung) was reported to the provider (Day 1). The result was communicated to the patient the next day (Day 2). The positive MCED test result resulted in aggressive evaluation of the mass. Biopsy of the liver nodule revealed hepatocellular carcinoma, moderately differentiated (Day 10). The cancer was subsequently classified as stage II. The mass was completely resected (Day 52). Prior to surgery, AFP level was 29.3 ng/mL (Day 13); after surgery, AFP level was 5.7 ng/mL (Day 66). The patient currently has no clinical symptoms (normal appetite and no weight loss, pain, or jaundice; Day 234). Discussion: The MCED test detected a cancer signal and predicted a liver CSO for an individual with stage II liver cancer. An indeterminate nodule was found in the patient 1 year prior to MCED test use with no resolution. Neither the CT scan results nor AFP level, which was lower than the AFP threshold (400 ng/mL) potentially indicative of hepatocellular carcinoma, would have led to this cancer being worked up without the MCED test. In conjunction with a positive MCED test result with a top-CSO prediction of liver, an aggressive workup took place resulting in diagnostic resolution within 1 month. Early-stage hepatocellular carcinoma has better prognosis and outcomes than late-stage disease. The use of the MCED test guided aggressive diagnostic workup and potentially improved outcomes for this patient.
Citation Format: Martin Poliak. A case of stage II hepatocellular carcinoma diagnosed using a multi-cancer early detection test. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P060.