ArticleCancer prevention research (Philadelphia, Pa.)2016
The Doylestown Algorithm: A Test to Improve the Performance of AFP in the Detection of Hepatocellular Carcinoma.
Article in Cancer prevention research (Philadelphia, Pa.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
49 citing papers in PubMed, 2 syntheses or guidelines pooled it, 90 citations in OpenAlex.
- Combinatorial Gene Expression Profiling of SerumInternational journal of molecular sciences · 2024Pooled it
- Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease.The Cochrane database of systematic reviews · 2021Pooled it
- Biomarker analysis of fucosylated kininogen through depletion of lectin reactive heterophilic antibodies in hepatocellular carcinoma.Journal of immunological methods · 2018Trial
- Early screening for liver cancer must be performed.World journal of hepatology · 2025Review
- BALAD-2 Emerges as the Most Accurate Prognostic Model in Hepatocellular Carcinoma: Results from a Biobank-Based Cohort Study.Cancers · 2025Article
- Decision-Making Biomarkers Guiding Therapeutic Strategies in Hepatocellular Carcinoma: From Prediction to Personalized Care.Cancers · 2025Review
- Article
- A novel nomogram based on machine learning predicting overall survival for hepatocellular carcinoma patients with dynamic α‑fetoprotein level changes after local resection.Oncology letters · 2025Article
- New insights into biomarkers and risk stratification to predict hepatocellular cancer.Molecular medicine (Cambridge, Mass.) · 2025Review
- [Current status and prospects for screening early-stage hepatocellular carcinoma].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Review
- Hepatocellular Carcinoma: The Search for an Optimal Screening Test.Middle East journal of digestive diseases · 2025Review
- Spatial omics-based machine learning algorithms for the early detection of hepatocellular carcinoma.Communications medicine · 2024Article
- Review
- MASLD-Related HCC: A Comprehensive Review of the Trends, Pathophysiology, Tumor Microenvironment, Surveillance, and Treatment Options.Current issues in molecular biology · 2024Review
- Alpha-fetoprotein: Past, present, and future.Hepatology communications · 2024Review
- Prediction of survival and analysis of prognostic factors for patients with AFP negative hepatocellular carcinoma: a population-based study.BMC gastroenterology · 2024Article
- Diagnosis of the Initial Stage of Hepatocellular Carcinoma: A Review.Current pharmaceutical design · 2024Review
- Mechanistically based blood proteomic markers in the TGF-β pathway stratify risk of hepatocellular cancer in patients with cirrhosis.Genes & cancer · 2024Article
- Hepatocellular Carcinoma from a Hepatologist's Perspective.Seminars in interventional radiology · 2023Review
- The Current Status of the Liver Liquid Biopsy in MASH Related HCC: Overview and Future Directions.Biomolecules · 2023Review
Corrections and comments
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Authors and funding
14 authors at 1 institution in 1 country.
Funding
Abstract
Biomarkers for the early diagnosis of hepatocellular carcinoma (HCC) are needed to decrease mortality from this cancer. However, as new biomarkers have been slow to be brought to clinical practice, we have developed a diagnostic algorithm that utilizes commonly used clinical measurements in those at risk of developing HCC. Briefly, as α-fetoprotein (AFP) is routinely used, an algorithm that incorporated AFP values along with four other clinical factors was developed. Discovery analysis was performed on electronic data from patients who had liver disease (cirrhosis) alone or HCC in the background of cirrhosis. The discovery set consisted of 360 patients from two independent locations. A logistic regression algorithm was developed that incorporated log-transformed AFP values with age, gender, alkaline phosphatase, and alanine aminotransferase levels. We define this as the Doylestown algorithm. In the discovery set, the Doylestown algorithm improved the overall performance of AFP by 10%. In subsequent external validation in over 2,700 patients from three independent sites, the Doylestown algorithm improved detection of HCC as compared with AFP alone by 4% to 20%. In addition, at a fixed specificity of 95%, the Doylestown algorithm improved the detection of HCC as compared with AFP alone by 2% to 20%. In conclusion, the Doylestown algorithm consolidates clinical laboratory values, with age and gender, which are each individually associated with HCC risk, into a single value that can be used for HCC risk assessment. As such, it should be applicable and useful to the medical community that manages those at risk for developing HCC.
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