Prospective Validation of Liver Cancer Risk Computation (LIRIC) Models

Study Overview
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Brief Summary
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The goal of this prospective observational cohort study is to validate previously developed Hepatocellular Carcinoma (HCC) risk prediction algorithms, the Liver Risk Computation (LIRIC) models, which are based on electronic health records. The main questions it aims to answer are: Will our retrospectively developed general population LIRIC models, developed on routine EHR data, perform similarly when prospectively validated, and reliably and accurately predict HCC in real-time? What is the average time from model deployment and risk prediction, to the date of HCC development and what is the stage of HCC at diagnosis? The risk model will be deployed on data from individuals eligible for the study. Each individual will be assigned a risk score and tracked over time to assess the model's discriminatory performance and calibration.

Detailed Description
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The investigators will conduct a prospective observational cohort study, separately deploying three separate LIRIC models (the general population, cirrhosis, and no_cirrhosis models) on retrospective de-identified EHR data of 44 HCOs in the USA, using the TriNetX federated network platform. LIRIC will generate a risk score for each individual. All risk-stratified individuals will be prospectively, electronically followed for up to 3-years to assess the primary end-point of HCC development. At the end of this period, model discrimination will be assessed, using the following metrics: AUROC, sensitivity, specificity, PPV/NPV. Risk scores generated by the model will be divided into quantiles. For each quantile, the investigators will evaluate the following: number of individuals in each quantile, number of HCC cases, PPV, NNS, SIR. Model calibration will be used for assessing the accuracy of estimates, based on the estimated to observed number of events. The model will dynamically re-evaluate all individual data every 6 months, re-classifying individuals (as needed).

Official Title
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Prospective Validation of Liver Cancer Risk Computation (LIRIC) Models on Multicenter EHR Data

Conditions
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Predictive Cancer Model

Intervention / Treatment
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* Other: Liver Risk Computation Model (LIRIC)
* Other: Liver Risk Computation Model (LIRIC)_cirrhosis
* Other: Liver Risk Computation Model (LIRIC)_no_cirrhosis


Participation Criteria
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Eligibility Criteria
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The investigators will utilize the following criteria for all 3 models: Inclusion criteria: Male and females age ≥40 years from all US HCOs available on the platform at least at least 2 clinical encounters to the HCO, within the last year, before the study start date Exclusion Criteria: Personal history of HCC or current HCC (ICD-9: 155.0; ICD-10: C22.0) Age below 40. The same dataset will be utilized for the non-cirrhosis validation, with exclusion of all cases with cirrhosis (ICD-9: 571.2, 571.5; ICD-10: K70, K70.3, K70.30, K70.31, K74, K74.0, K74.6, K74.60, K74.69). For the cirrhosis validation, the investigators will include only patients with the above cirrhosis codes.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| prospective general population cohort<br>Males and females age >= 40 years, without a personal history of HCC or current HCC and at least two clinical visits to their HCO, within the last year, before the study start date. | Other: Liver Risk Computation Model (LIRIC)<br>* A neural network model (LIRIC-NN) and a logistic regression model (LIRIC-LR) that use routinely collected EHR data to stratify individuals into HCC risk groups for the general population<br>|
| Prospective cirrhosis population cohort<br>Males and females age >= 40 years, with liver cirrhosis and without a personal history of HCC or current HCC, that have at least two clinical visits to their HCO, within the last year, before the study start date. | Other: Liver Risk Computation Model (LIRIC)_cirrhosis<br>* A neural network model (LIRIC-NN) and a logistic regression model (LIRIC-LR) that use routinely collected EHR data to stratify individuals into HCC risk groups for the population with liver cirrhosis<br>|
| Prospective no_cirrhosis population cohort<br>Males and females age >= 40 years, without a personal history of HCC or current HCC and without a diagnosis of liver cirrhosis, that have at least two clinical visits to their HCO, within the last year, before the study start date. | Other: Liver Risk Computation Model (LIRIC)_no_cirrhosis<br>* neural network model (LIRIC-NN) and a logistic regression model (LIRIC-LR) that use routinely collected EHR data to stratify individuals into HCC risk groups for the population without liver cirrhosis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Area under the receiver operating characteristic curve (AUROC) of LIRIC for all groups stratified | To assess the discriminatory performance of LIRIC for prospective identification of high-risk individuals for HCC development. ROCs and AUROC numbers will be calculated for the whole population and groups stratified by age, sex, race, and geographical location. | 6 months from index date, at 1 year, 2 years and 3 years | 
| Calibration of LIRIC for all groups stratified | To assess how well the risk prediction by LIRIC aligns with observed risk without recalibration. Calibration plots will be created for the whole population and groups stratified by age, sex, race, and geographical location. | 6 months from index date, at 1 year, 2 years and 3 years | 
| Performance metrics for LIRIC model risk quantiles | To evaluate the sensitivity, specificity, number of individuals/number of HCC cases, PPV, NNS in each predicted risk quantile for multiple risk thresholds | 6 months from index date, at 1 year, 2 years and 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Timing of incident HCC occurrence | To evaluate how long in advance before HCC occurrence should be expected for LIRIC models to make high-risk predictions based on different thresholds for high-risk. Distribution plots of the date of HCC incidence for multiple risk thresholds will be created. | 6 months from index date, at 1 year, 2 years and 3 years | 
| Tumor stage at HCC diagnosis | TNM staging at HCC diagnosis | 6 months from index date, at 1 year, 2 years and 3 years |