Principal Investigator

Amit
Singal
Awardee Organization

Ut Southwestern Medical Center
United States

Fiscal Year
2022
Activity Code
U01
Early Stage Investigator Grants (ESI)
Not Applicable
Project End Date

Precision Risk Stratification and Screening for HCC among Patients with Cirrhosis in the United States

Hepatocellular carcinoma (HCC)-related mortality in the U.S. is rapidly rising. Given the association between early detection and improved survival, screening using ultrasound +/- a serum biomarker, alpha fetoprotein (AFP), is recommended in at-risk individuals, including all patients with cirrhosis. However, most HCC patients are diagnosed at a late stage due to limitations in this strategy. Specifically, the strategy of ultrasound and AFP in all cirrhosis patients is inadequate because it ignores: 1) heterogeneity in risk between patients; 2) the poor accuracy of screening tests; and 3) the poor reliability of screening test performance between patients. The current “one-size-fits-all” approach to HCC screening leads to over-screening of low-risk cirrhosis patients and under-screening of high-risk patients, diluting the overall value of HCC screening. Our proposal's goal is to develop and evaluate a precision screening strategy for early stage HCC in patients with cirrhosis that matches the best screening tests to individual risk and screening test performance. We will leverage five patient populations (4 prospective cohorts and one case-control dataset) with a total of >6000 cirrhosis patients to evaluate and compare biomarker- and imaging-based models for HCC risk stratification and early detection. Specifically, we propose to: Aim 1: Validate and compare the performance of two risk stratification models to stratify cirrhosis patients with low-, intermediate- and high-risk of developing HCC Aim 2: Evaluate the performance of an abbreviated MRI protocol +/- serum biomarkers (including AFP, AFP L3, and DCP) vs. ultrasound +/- serum biomarkers for early HCC detection in patients with cirrhosis Aim 3: Compare the cost effectiveness, using micro-simulation modeling, of a tailored screening strategy based on individual HCC risk and expected screening test performance to the current standard strategy of ultrasound and AFP in all patients with cirrhosis Our proposal leverages 5 distinct patient populations with >6000 cirrhosis patients, to compare biomarker- and imaging-based models for HCC risk stratification and early detection. We use these data to compare the effectiveness of a tailored screening strategy to the current strategy of ultrasound and AFP for all patients using micro-simulation modeling. Tailoring HCC screening efforts to individual risk and screening test performance moves beyond the current “one-size-fits-all” strategy and aligns HCC screening with the principles of precision medicine. Our proposed HCC screening strategy would maximize screening benefits and minimize screening harms for each patient, thereby optimizing overall HCC screening value in the United States. 2

Publications

  • Fetzer DT, Browning T, Xi Y, Yokoo T, Singal AG. Associations of Ultrasound LI-RADS Visualization Score With Examination, Sonographer, and Radiologist Factors: Retrospective Assessment in Over 10,000 Examinations. AJR. American journal of roentgenology. 2022 Jun;218(6):1010-1020. Epub 2021 Dec 15. PMID: 34910539
  • Rao A, Rich NE, Marrero JA, Yopp AC, Singal AG. Diagnostic and Therapeutic Delays in Patients With Hepatocellular Carcinoma. Journal of the National Comprehensive Cancer Network : JNCCN. 2021 May 28;19(9):1063-1071. PMID: 34077908
  • Rich NE, Marrero JA, Singal AG. REPLY. Hepatology (Baltimore, Md.). 2021 Jun;73(6):2618-2619. Epub 2021 May 17. PMID: 33205463
  • Chong N, Schoenberger H, Yekkaluri S, Fetzer DT, Rich NE, Yokoo T, Gopal P, Manwaring C, Quirk L, Singal AG. Association between ultrasound quality and test performance for HCC surveillance in patients with cirrhosis: a retrospective cohort study. Alimentary pharmacology & therapeutics. 2022 Mar;55(6):683-690. Epub 2022 Feb 15. PMID: 35170052
  • Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, Waljee AK, Singal AG. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018 May;154(6):1706-1718.e1. Epub 2018 Feb 6. PMID: 29425931
  • Park HJ, Lee TY, Kim SY, Kim MJ, Singal AG, Lee SJ, Won HJ, Byun JH, Lim YS. Hypervascular transformation of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement on gadoxetic acid-enhanced MRI: long-term follow-up in a surveillance cohort. European radiology. 2022 Aug;32(8):5064-5074. Epub 2022 Feb 28. PMID: 35229195
  • Rich NE, John BV, Parikh ND, Rowe I, Mehta N, Khatri G, Thomas SM, Anis M, Mendiratta-Lala M, Hernandez C, Odewole M, Sundaram LT, Konjeti VR, Shetty S, Shah T, Zhu H, Yopp AC, Hoshida Y, Yao FY, Marrero JA, Singal AG. Hepatocellular Carcinoma Demonstrates Heterogeneous Growth Patterns in a Multicenter Cohort of Patients With Cirrhosis. Hepatology (Baltimore, Md.). 2020 Nov;72(5):1654-1665. Epub 2020 Oct 25. PMID: 32017165
  • Singal AG, Hoshida Y, Pinato DJ, Marrero J, Nault JC, Paradis V, Tayob N, Sherman M, Lim YS, Feng Z, Lok AS, Rinaudo JA, Srivastava S, Llovet JM, Villanueva A. International Liver Cancer Association (ILCA) White Paper on Biomarker Development for Hepatocellular Carcinoma. Gastroenterology. 2021 Jun;160(7):2572-2584. Epub 2021 Mar 9. PMID: 33705745
  • Lee YT, Karim MA, Kum HC, Park S, Rich NE, Noureddin M, Singal AG, Yang JD. Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma. Clinical and molecular hepatology. 2023 Apr;29(2):453-464. Epub 2023 Feb 1. PMID: 36726052
  • Wolf E, Rich NE, Marrero JA, Parikh ND, Singal AG. Use of Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis: A Systematic Review and Meta-Analysis. Hepatology (Baltimore, Md.). 2021 Feb;73(2):713-725. Epub 2020 Nov 20. PMID: 32383272
  • Singal AG, Reddy S, Radadiya Aka Patel H, Villarreal D, Khan A, Liu Y, Cerda V, Rich NE, Murphy CC, Tiro JA, Kramer JR, Hernaez R. Multicenter Randomized Clinical Trial of a Mailed Outreach Strategy for Hepatocellular Carcinoma Surveillance. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Dec;20(12):2818-2825.e1. Epub 2021 Dec 10. PMID: 34902568
  • Arvind A, Joshi S, Zaki T, Burkholder D, Parikh ND, Singal AG, North American Liver Cancer (NALC) Consortium, Yekkaluri S, Yokoo T, Fetzer D, Browning T, Rich NE, Khatri G, Zhu H, Hoshida Y, Marrero JA, Yopp AC, Gopal P, Manwaring C. Risk of Hepatocellular Carcinoma in Patients With Indeterminate (LI-RADS 3) Liver Observations. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 Apr;21(4):1091-1093.e3. Epub 2021 Dec 10. PMID: 34902571
  • Wang M, Singal AG, Parikh N, Kono Y, Marrero J, Mehta A. A Biomarker Panel Based upon AFP, Fucosylated Kininogen and PEG-Precipitated IgG Is Highly Accurate for the Early Detection Hepatocellular Carcinoma in Patients with Cirrhosis in Phase II and Phase III Biomarker Evaluation. Cancers. 2022 Dec 2;14. (23). PMID: 36497452
  • Parikh ND, Mehta N, Hoteit MA, Yang JD, John BV, Moon AM, Salgia RJ, Pillai A, Kassab I, Saeed N, Thyssen E, Nathani P, McKinney J, Chan W, Durkin C, Connor M, Alsudaney M, Konjeti R, Durand B, Nissen NN, Kim HP, Paknikar R, Rich NE, Schipper MJ, Singal AG. Association between sustained virological response and clinical outcomes in patients with hepatitis C infection and hepatocellular carcinoma. Cancer. 2022 Oct 1;128(19):3470-3478. Epub 2022 Jul 7. PMID: 35796530
  • Singal AG, Tayob N, Mehta A, Marrero JA, El-Serag H, Jin Q, Saenz de Viteri C, Fobar A, Parikh ND. GALAD demonstrates high sensitivity for HCC surveillance in a cohort of patients with cirrhosis. Hepatology (Baltimore, Md.). 2022 Mar;75(3):541-549. Epub 2021 Dec 17. PMID: 34618932
  • Lee YT, Wang JJ, Luu M, Noureddin M, Kosari K, Agopian VG, Rich NE, Lu SC, Tseng HR, Nissen NN, Singal AG, Yang JD. The Mortality and Overall Survival Trends of Primary Liver Cancer in the United States. Journal of the National Cancer Institute. 2021 Nov 2;113(11):1531-1541. PMID: 34010422
  • Kanneganti M, Marrero JA, Parikh ND, Kanwal F, Yokoo T, Mendiratta-Lala M, Rich NE, Gopal P, Singal AG. Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2022 Dec;28(12):1865-1875. Epub 2022 Sep 5. PMID: 35980600
  • Singal AG, Lok AS, Feng Z, Kanwal F, Parikh ND. Conceptual Model for the Hepatocellular Carcinoma Screening Continuum: Current Status and Research Agenda. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Jan;20(1):9-18. Epub 2020 Sep 19. PMID: 32961340
  • Singal AG, Yang JD, Parikh ND. Blood-Based Biomarkers for HCC Surveillance: Ready for the Center Stage? The American journal of gastroenterology. 2023 Oct 27. Epub 2023 Oct 27. PMID: 37795908
  • Parikh ND, Tayob N, Singal AG. Blood-based biomarkers for hepatocellular carcinoma screening: Approaching the end of the ultrasound era? Journal of hepatology. 2023 Jan;78(1):207-216. Epub 2022 Sep 8. PMID: 36089157
  • Parikh ND, Mehta AS, Singal AG, Block T, Marrero JA, Lok AS. Biomarkers for the Early Detection of Hepatocellular Carcinoma. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2020 Dec;29(12):2495-2503. Epub 2020 Apr 1. PMID: 32238405
  • Singal AG, Zhang E, Narasimman M, Rich NE, Waljee AK, Hoshida Y, Yang JD, Reig M, Cabibbo G, Nahon P, Parikh ND, Marrero JA. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis. Journal of hepatology. 2022 Jul;77(1):128-139. Epub 2022 Feb 6. PMID: 35139400
  • Karim MA, Singal AG, Kum HC, Lee YT, Park S, Rich NE, Noureddin M, Yang JD. Clinical Characteristics and Outcomes of Nonalcoholic Fatty Liver Disease-Associated Hepatocellular Carcinoma in the United States. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 Mar;21(3):670-680.e18. Epub 2022 Mar 17. PMID: 35307595
  • Dunn C, Lin B, Rich NE, Patel MS, Gopal P, Singal AG. Correlation of LI-RADS 3 or 4 Observations with Histopathologic Diagnosis in Patients with Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 May;21(5):1351-1353.e2. Epub 2022 Mar 17. PMID: 35307596
  • Lee YT, Fujiwara N, Yang JD, Hoshida Y. Risk stratification and early detection biomarkers for precision HCC screening. Hepatology (Baltimore, Md.). 2023 Jul 1;78(1):319-362. Epub 2022 Oct 11. PMID: 36082510
  • Singal AG, Reig M, Villanueva A. Emerging Tools for Hepatocellular Carcinoma Surveillance. The American journal of gastroenterology. 2022 Dec 1;117(12):1948-1951. Epub 2022 Sep 16. PMID: 36114768
  • Singal AG, El-Serag HB. Rational HCC screening approaches for patients with NAFLD. Journal of hepatology. 2022 Jan;76(1):195-201. Epub 2021 Sep 9. PMID: 34508791
  • Liu PH, Hsu CY, Su CW, Huang YH, Hou MC, Rich NE, Fujiwara N, Hoshida Y, Singal AG, Huo TI. Thrombocytosis is associated with worse survival in patients with hepatocellular carcinoma. Liver international : official journal of the International Association for the Study of the Liver. 2020 Oct;40(10):2522-2534. Epub 2020 Jun 28. PMID: 32511831
  • Zhu J, Huang J, Zhang J, Chen Z, Lin Y, Grigorean G, Li L, Liu S, Singal AG, Parikh ND, Lubman DM. Glycopeptide Biomarkers in Serum Haptoglobin for Hepatocellular Carcinoma Detection in Patients with Nonalcoholic Steatohepatitis. Journal of proteome research. 2020 Aug 7;19(8):3452-3466. Epub 2020 May 29. PMID: 32412768
  • Woolen SA, Singal AG, Davenport MS, Troost JP, Khalatbari S, Mittal S, Siddiqui S, Fobar A, Morris J, Odewole M, Tapper EB, Pillai A, Parikh ND. Patient Preferences for Hepatocellular Carcinoma Surveillance Parameters. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Jan;20(1):204-215.e6. Epub 2021 Feb 19. PMID: 33618022
  • Mechref Y, Peng W, Gautam S, Ahmadi P, Lin Y, Zhu J, Zhang J, Liu S, Singal AG, Parikh ND, Lubman DM. Mass spectrometry based biomarkers for early detection of HCC using a glycoproteomic approach. Advances in cancer research. 2023;157:23-56. Epub 2022 Sep 6. PMID: 36725111
  • Singal AG, Rich NE, Mehta N, Branch A, Pillai A, Hoteit M, Volk M, Odewole M, Scaglione S, Guy J, Said A, Feld JJ, John BV, Frenette C, Mantry P, Rangnekar AS, Oloruntoba O, Leise M, Jou JH, Bhamidimarri KR, Kulik L, Tran T, Samant H, Dhanasekaran R, Duarte-Rojo A, Salgia R, Eswaran S, Jalal P, Flores A, Satapathy SK, Wong R, Huang A, Misra S, Schwartz M, Mitrani R, Nakka S, Noureddine W, Ho C, Konjeti VR, Dao A, Nelson K, Delarosa K, Rahim U, Mavuram M, Xie JJ, Murphy CC, Parikh ND. Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study. Gastroenterology. 2019 May;156(6):1683-1692.e1. Epub 2019 Jan 18. PMID: 30660729
  • Murphy CC, Tavakkoli A, Wani S, Singal AG. Pandemic-Related Changes in Incidence and Mortality Rates of Gastrointestinal Cancers During 2020. The American journal of gastroenterology. 2024 Feb 1;119(2):382-387. Epub 2023 Oct 27. PMID: 37791616
  • Park HJ, Kim SY, Singal AG, Lee SJ, Won HJ, Byun JH, Choi SH, Yokoo T, Kim MJ, Lim YS. Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high-risk patients. Liver international : official journal of the International Association for the Study of the Liver. 2022 Aug;42(9):2080-2092. Epub 2021 Nov 29. PMID: 34817921
  • Lin Y, Zhu J, Pan L, Zhang J, Tan Z, Olivares J, Singal AG, Parikh ND, Lubman DM. A Panel of Glycopeptides as Candidate Biomarkers for Early Diagnosis of NASH Hepatocellular Carcinoma Using a Stepped HCD Method and PRM Evaluation. Journal of proteome research. 2021 Jun 4;20(6):3278-3289. Epub 2021 Apr 30. PMID: 33929864
  • Melendez-Torres J, Singal AG. Early detection of hepatocellular carcinoma: roadmap for improvement. Expert review of anticancer therapy. 2022 Jun;22(6):621-632. Epub 2022 May 10. PMID: 35514249
  • Rich NE, Singal AG. Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines? Hepatology (Baltimore, Md.). 2022 Mar;75(3):740-753. Epub 2022 Jan 18. PMID: 34923659
  • Parikh ND, Singal AG, Hutton DW, Tapper EB. Cost-Effectiveness of Hepatocellular Carcinoma Surveillance: An Assessment of Benefits and Harms. The American journal of gastroenterology. 2020 Oct;115(10):1642-1649. PMID: 32530829
  • Kanwal F, Khaderi S, Singal AG, Marrero JA, Loo N, Asrani SK, Amos CI, Thrift AP, Gu X, Luster M, Al-Sarraj A, Ning J, El-Serag HB. Risk factors for HCC in contemporary cohorts of patients with cirrhosis. Hepatology (Baltimore, Md.). 2023 Mar 1;77(3):997-1005. Epub 2023 Feb 17. PMID: 35229329
  • Singal AG, Parikh ND, Hoshida Y. Precision HCC Surveillance: It Is All in the Number (Needed). Digestive diseases and sciences. 2023 Mar;68(3):720-722. Epub 2022 Oct 27. PMID: 36302995
  • Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2020 Nov;18(12):2650-2666. Epub 2019 Aug 8. PMID: 31401364
  • Kanwal F, Singal AG. Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction. Gastroenterology. 2019 Jul;157(1):54-64. Epub 2019 Apr 12. PMID: 30986389
  • Singal AG, Patibandla S, Obi J, Fullington H, Parikh ND, Yopp AC, Marrero JA. Benefits and Harms of Hepatocellular Carcinoma Surveillance in a Prospective Cohort of Patients With Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2021 Sep;19(9):1925-1932.e1. Epub 2020 Sep 10. PMID: 32920214
  • Gutierrez Reyes CD, Huang Y, Atashi M, Zhang J, Zhu J, Liu S, Parikh ND, Singal AG, Dai J, Lubman DM, Mechref Y. PRM-MS Quantitative Analysis of Isomeric N-Glycopeptides Derived from Human Serum Haptoglobin of Patients with Cirrhosis and Hepatocellular Carcinoma. Metabolites. 2021 Aug 23;11. (8). PMID: 34436504
  • Karim MA, Ramezani M, Leroux T, Kum HC, Singal AG. Healthcare Costs for Medicare Patients With Hepatocellular Carcinoma in the United States. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 Aug;21(9):2327-2337.e9. Epub 2022 Nov 24. PMID: 36435358
  • Parikh ND, Tayob N, Al-Jarrah T, Kramer J, Melcher J, Smith D, Marquardt P, Liu PH, Tang R, Kanwal F, Singal AG. Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort. JAMA network open. 2022 Jul 1;5(7):e2223504. PMID: 35867057
  • Yokoo T, Masaki N, Parikh ND, Lane BF, Feng Z, Mendiratta-Lala M, Lee CH, Khatri G, Marsh TL, Shetty K, Dunn CT, Al-Jarrah T, Aslam A, Davenport MS, Gopal P, Rich NE, Lok AS, Singal AG. Multicenter Validation of Abbreviated MRI for Detecting Early-Stage Hepatocellular Carcinoma. Radiology. 2023 Apr;307(2):e220917. Epub 2023 Jan 24. PMID: 36692401
  • Toyoda H, Hiraoka A, Olivares J, Al-Jarrah T, Devlin P, Kaneoka Y, Maeda A, Yopp AC, Parikh ND, Singal AG. Outcome of Hepatocellular Carcinoma Detected During Surveillance: Comparing USA and Japan. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2021 Nov;19(11):2379-2388.e6. Epub 2020 Oct 22. PMID: 33295281
  • Serper M, Parikh ND, Thiele G, Ovchinsky N, Mehta S, Kuo A, Ho C, Kanwal F, Volk M, Asrani SK, Ghabril MS, Lake JR, Merriman RB, Morgan TR, Tapper EB. Patient-reported outcomes in HCC: A scoping review by the Practice Metrics Committee of the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md.). 2022 Jul;76(1):251-274. Epub 2022 Jan 22. PMID: 34990516
  • Antwi SO, Heckman M, White L, Yan I, Sarangi V, Lauer KP, Reddy J, Ahmed F, Veliginti S, Mejías Febres ED, Hatia RI, Chang P, Izquierdo-Sanchez L, Boix L, Rojas A, Banales JM, Reig M, Stål P, Gómez MR, Singal AG, Li D, Hassan MM, Roberts LR, Patel T. Metabolic liver cancer: associations of rare and common germline variants in one-carbon metabolism and DNA methylation genes. Human molecular genetics. 2023 Aug 7;32(16):2646-2655. PMID: 37369012
  • Benhammou JN, Rich NE, Cholankeril G, Zhang P, Zeng W, Rao S, Tayob N, National Cancer Institute’s Translational Liver Consortium Early-Career Working Group, Li W, Wu X, Feng S, Fujiwara N, Meng X, Zhu S, Zaidi S. DETECT: Development of Technologies for Early HCC Detection. Gastroenterology. 2022 Jul;163(1):21-27. Epub 2022 Mar 23. PMID: 35339460
  • Onyirioha K, Joshi S, Burkholder D, Yekkaluri S, Parikh ND, Singal AG, North American Liver Cancer (NALC) Consortium, Wolf E, Yokoo T, Browning T, Mendiratta-Lala M, Rich NE, Gopal P. Clinical Outcomes of Patients With Suspicious (LI-RADS 4) Liver Observations. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 Jun;21(6):1649-1651.e2. Epub 2022 Apr 9. PMID: 35413448
  • Brown AM, Kassab I, Massani M, Townsend W, Singal AG, Soydal C, Moreno-Luna L, Roberts LR, Chen VL, Parikh ND. TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta analysis. Cancer medicine. 2023 Feb;12(3):2590-2599. Epub 2022 Aug 9. PMID: 35943116
  • Fujiwara N, Kobayashi M, Fobar AJ, Hoshida A, Marquez CA, Koneru B, Panda G, Taguri M, Qian T, Raman I, Li QZ, Hoshida H, Sezaki H, Kumada H, Tateishi R, Yokoo T, Yopp AC, Chung RT, Fuchs BC, Baumert TF, Marrero JA, Parikh ND, Zhu S, Singal AG, Hoshida Y. A blood-based prognostic liver secretome signature and long-term hepatocellular carcinoma risk in advanced liver fibrosis. Med (New York, N.Y.). 2021 Jul 9;2(7):836-850.e10. Epub 2021 Apr 21. PMID: 34318286
  • Singal AG, Ghaziani TT, Mehta N, Zhou K, Grinspan LT, Benhammou JN, Moon AM, Yang JD, Salgia R, Pillai A, Zheng E, Rich NE, Gopal P, Jalal P, Verna E, Yekkaluri S, Phen S, Melendez-Torres J, Alshuwaykh O, Choi H, Junus K, Grady J, Song M, Leven EA, Yum J, Gowda V, Alsudaney M, Hernandez P, Desai N, Parikh ND. Recall patterns and risk of primary liver cancer for subcentimeter ultrasound liver observations: a multicenter study. Hepatology communications. 2023 Mar 7;7. (3). doi: 10.1097/HC9.0000000000000073. eCollection 2023 Mar 1. PMID: 36881615
  • Oselio B, Singal AG, Zhang X, Van T, Liu B, Zhu J, Waljee AK. Reinforcement learning evaluation of treatment policies for patients with hepatitis C virus. BMC medical informatics and decision making. 2022 Mar 11;22(1):63. PMID: 35272662
  • Fujiwara N, Kubota N, Zhu S, Nakagawa S, Baba H, Hoshida Y. Disseminative Recurrence Signature for Hepatocellular Carcinoma From Nonalcoholic Fatty Liver Disease. Gastro hep advances. 2023;2(5):681-683. Epub 2023 Mar 20. PMID: 37621719
  • Schoenberger H, Chong N, Fetzer DT, Rich NE, Yokoo T, Khatri G, Olivares J, Parikh ND, Yopp AC, Marrero JA, Singal AG. Dynamic Changes in Ultrasound Quality for Hepatocellular Carcinoma Screening in Patients With Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Jul;20(7):1561-1569.e4. Epub 2021 Jun 10. PMID: 34119640
  • Seif El Dahan K, Daher D, Singal AG. Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease. Clinical and molecular hepatology. 2023 Feb;29(Suppl):S207-S219. Epub 2022 Sep 14. PMID: 36103899
  • Hernaez R, Karvellas CJ, Liu Y, Sacleux SC, Khemichian S, Stein LL, Shetty K, Lindenmeyer CC, Boike JR, Simonetto DA, Rahimi RS, Jalal PK, Izzy M, Kriss MS, Im GY, Lin MV, Jou JH, Fortune BE, Cholankeril G, Kuo A, Mahmud N, Kanwal F, Saliba F, Sundaram V, Artzner T, Jalan R, Multi-Organ Dysfunction and Evaluation for Liver Transplantation (MODEL) Consortium, Al Attar A, Kosari K, Garcia R, Salmastyan G, Cranford W, Patel P, Xue P, Mishra S, Parks M, Flocco G, Gao J, Wu T, Thanneeru P, Reddy V, Gao J, Hurtado M, Mohamed I, Vyhmeister R, Lopez CR, Campbell B, Winters AC, Simpson MA, Ying X. The novel SALT-M score predicts 1-year post-transplant mortality in patients with severe acute-on-chronic liver failure. Journal of hepatology. 2023 Sep;79(3):717-727. Epub 2023 Jun 12. PMID: 37315809
  • Singal AG, Tayob N, Mehta A, Marrero JA, Jin Q, Lau J, Parikh ND. Doylestown Plus and GALAD Demonstrate High Sensitivity for HCC Detection in Patients With Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Apr;20(4):953-955.e2. Epub 2021 Apr 20. PMID: 33864933
  • Marquardt P, Liu PH, Immergluck J, Olivares J, Arroyo A, Rich NE, Parikh ND, Yopp AC, Singal AG. Hepatocellular Carcinoma Screening Process Failures in Patients with Cirrhosis. Hepatology communications. 2021 Sep;5(9):1481-1489. Epub 2021 May 4. PMID: 34510836
  • Harding-Theobald E, Louissaint J, Maraj B, Cuaresma E, Townsend W, Mendiratta-Lala M, Singal AG, Su GL, Lok AS, Parikh ND. Systematic review: radiomics for the diagnosis and prognosis of hepatocellular carcinoma. Alimentary pharmacology & therapeutics. 2021 Oct;54(7):890-901. Epub 2021 Aug 12. PMID: 34390014
  • Singal AG, Parikh ND. Reply. Hepatology (Baltimore, Md.). 2022 Aug;76(2):E40-E41. Epub 2022 Apr 24. PMID: 35302647
  • Khatri G, Pedrosa I, Ananthakrishnan L, de Leon AD, Fetzer DT, Leyendecker J, Singal AG, Xi Y, Yopp A, Yokoo T. Abbreviated-protocol screening MRI vs. complete-protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: An equivalence study using LI-RADS v2018. Journal of magnetic resonance imaging : JMRI. 2020 Feb;51(2):415-425. Epub 2019 Jun 18. PMID: 31209978
  • Huang DQ, Singal AG, Kono Y, Tan DJH, El-Serag HB, Loomba R. Changing global epidemiology of liver cancer from 2010 to 2019: NASH is the fastest growing cause of liver cancer. Cell metabolism. 2022 Jul 5;34(7):969-977.e2. Epub 2022 Jun 3. PMID: 35793659
  • Rich NE, Parikh ND, Singal AG. REPLY. Hepatology (Baltimore, Md.). 2021 Sep;74(3):1715. Epub 2021 Jun 7. PMID: 33617660
  • Chen VL, Xu D, Wicha MS, Lok AS, Parikh ND. Utility of Liquid Biopsy Analysis in Detection of Hepatocellular Carcinoma, Determination of Prognosis, and Disease Monitoring: A Systematic Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2020 Dec;18(13):2879-2902.e9. Epub 2020 Apr 11. PMID: 32289533
  • Sanchez JI, Jiao J, Kwan SY, Veillon L, Warmoes MO, Tan L, Odewole M, Rich NE, Wei P, Lorenzi PL, Singal AG, Beretta L. Lipidomic Profiles of Plasma Exosomes Identify Candidate Biomarkers for Early Detection of Hepatocellular Carcinoma in Patients with Cirrhosis. Cancer prevention research (Philadelphia, Pa.). 2021 Oct;14(10):955-962. Epub 2021 Jul 12. PMID: 34253566
  • Thrift AP, Kanwal F, Liu Y, Khaderi S, Singal AG, Marrero JA, Loo N, Asrani SK, Luster M, Al-Sarraj A, Ning J, Tsavachidis S, Gu X, Amos CI, El-Serag HB. Risk stratification for hepatocellular cancer among patients with cirrhosis using a hepatic fat polygenic risk score. PloS one. 2023 Feb 28;18(2):e0282309. doi: 10.1371/journal.pone.0282309. eCollection 2023. PMID: 36854015
  • Govalan R, Luu M, Lauzon M, Kosari K, Ahn JC, Rich NE, Nissen N, Roberts LR, Singal AG, Yang JD. Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact. Hepatology communications. 2022 Jan;6(1):223-236. Epub 2021 Aug 25. PMID: 34558830
  • Kanwal F, Khaderi S, Singal AG, Marrero JA, Asrani SK, Amos CI, Thrift AP, Kramer JR, Yu X, Cao Y, Luster M, Al-Sarraj A, Ning J, El-Serag HB. Risk Stratification Model for Hepatocellular Cancer in Patients With Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2023 Dec;21(13):3296-3304.e3. Epub 2023 Apr 30. PMID: 37390101
  • Dhanasekaran R, Suzuki H, Lemaitre L, Kubota N, Hoshida Y. Molecular and immune landscape of hepatocellular carcinoma to guide therapeutic decision-making. Hepatology (Baltimore, Md.). 2023 Jun 12. Epub 2023 Jun 12. PMID: 37300379
  • Singal AG, Sanduzzi-Zamparelli M, Nahon P, Ronot M, Hoshida Y, Rich N, Reig M, Vilgrain V, Marrero J, Llovet JM, Parikh ND, Villanueva A. International Liver Cancer Association (ILCA) white paper on hepatocellular carcinoma risk stratification and surveillance. Journal of hepatology. 2023 Jul;79(1):226-239. Epub 2023 Feb 26. PMID: 36854345
  • Singal AG, Schoenberger H, Fetzer D. Reply. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Jul;20(7):1618-1619. Epub 2021 Aug 16. PMID: 34411711
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