Meta-analysis: accuracy of the Baveno VI criteria for the diagnosis of high-risk varices in patients with hepatocellular carcinoma

Xiaoqin Zheng; Tingting Mei; Hui Xu; Heran Yin; Hua Jin; Chunyan Gou; Xiaojun Wang; Huiguo Ding

doi:10.3389/fonc.2024.1482290

Meta-analysis: accuracy of the Baveno VI criteria for the diagnosis of high-risk varices in patients with hepatocellular carcinoma

Front Oncol. 2024 Oct 4:14:1482290. doi: 10.3389/fonc.2024.1482290. eCollection 2024.

Authors

Xiaoqin Zheng^#¹, Tingting Mei^#², Hui Xu¹, Heran Yin¹, Hua Jin¹, Chunyan Gou¹, Xiaojun Wang¹, Huiguo Ding³

Affiliations

¹ Integrated Traditional Chinese and Western Medicine Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.
² Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China.
³ Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Background and aim: Diagnosing high-risk varices (HRV) is crucial for determining the prognosis and treatment strategy in patients with hepatocellular carcinoma (HCC). Although the Baveno VI consensus guidelines have been validated for assessing HRV in patients with liver cirrhosis, their applicability to those with HCC remains uncertain. This study aims to evaluate the effectiveness of the Baveno VI criteria in screening for HRV in patients with HCC.

Methods: We searched for English-language articles related to Baveno criteria and HCC across PubMed, Embase, Web of Science, and Cochrane databases, covering publications from their inception until April 19, 2024. Our meta-analysis was conducted using STATA 14.0 and Meta-Disc 1.4 software. We assessed the quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We analyzed pooled sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) using a random-effects model and constructed a summary receiver operating characteristic (SROC) curve. Based on established consensus, the favorable Baveno VI criteria were defined as a liver stiffness measurement (LSM) < 20 kPa and a platelet count (PLT) > 150×10⁹/L to exclude HRV. This study is registered with PROSPERO under the registration number CRD42024533946.

Results: We finally brought four studies, including 1277 patients with HCC, into this meta-analysis. The SEN, SPE, DOR, and AUC of favorable Baveno VI criteria in screening HRV in patients with HCC were 0.90 (95% CI: 0.81-0.95), 0.33 (95% CI: 0.25-0.41), 4.44 (95% CI: 2.14-9.22), and 0.59 (95% CI: 0.55-0.64), respectively. The LR+ and LR- of the favorable Baveno VI criteria were 1.34 (95% CI: 1.19-1.50) and 0.30 (95% CI: 0.16-0.58), respectively. Subgroup and meta-regression analyses indicated that BCLC and Child-Pugh stages likely contribute to the heterogeneity in the SPE.

Conclusions: The favorable Baveno VI criteria may not effectively screen HRV in patients with HCC. However, the current evidence is insufficient, and further studies with larger sample sizes and detailed patient subgroups are needed.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024533946.

Keywords: Baveno criteria; hepatocellular carcinoma; high-risk varices; liver stiffness measurement; meta-analysis; platelet.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Capital Medical Development and Research Fund (2022–1–2181), Beijing Municipal Science and Technology Commission (Z221100007422002), State Administration of Traditional Chinese Medicine of People's Republic of China (ZYYZDXK-2023002), and the Scientific Research Project of Beijing Youan Hospital, CCMU, 2019 (BJYAYY CY2019-12).