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Paranaguá-Vezozzo et al. Hepatoma Res 2018;4:11  I  http://dx.doi.org/10.20517/2394-5079.2018.17                         Page 9 of 11


               population between ages of 38 and 77 years, and still requires external validation with other etiologies, but
               a bootstrap internal validation was applied and we accessed the optimal diagnostic measures such that our
               model score is still useful, practical, readily available and easy to apply in primary or tertiary health centers
               in developing countries.

               In conclusion, a score model was created from the results of the case control study based on serum levels of
               ALT, AFP and platelet count. This score facilitates the identification of patients with small diameter HCC (≤ 3 cm),
               and mainly those at lowest risk of its presence in the absence of ALT, AFP and platelet count alterations
               in the thresholds defined in this study. The score is not intended to predict HCC development. Instead, its
               strength is to rule out small HCC in HCV cirrhotic patients, considering that the negative predictive value
               of those classified as low risk of HCC presence was 99.1%. This information may assist screening strategies in
               the population of patients with HCV-related cirrhosis. Further studies in other populations, including non-
               HCV related cirrhosis are needed to address its role in HCC detection.


               DECLARATIONS
               Authors’ contributions
               Designed and performed the research: Paranaguá-Vezozzo DC, Matielo CEL
               Analyzed data and wrote the article: Paranaguá-Vezozzo DC, de Campos Mazo DF
               Revised the article critically: Nacif LS, Pessoa MG, Pereira GLR, de Lima RGR, Zitelli PMY, Ono SK,
               Carrilho FJ
               Approved the final version of the manuscript: all authors


               Data source and availability
               The relevant raw data from this study can be available upon request for non-commercial purpose to the
               corresponding author.

               Financial support and sponsorship
               This study was in part supported by Alves de Queiroz Family Fund for Research. The funders had no role in
               study design, data collection and analysis, decision to publish, or preparation of the manuscript.


               Conflicts of interest
               The authors declare no conflicts of interest in this work.

               Patient consent
               Informed consent was obtained.

               Ethics approval
               This study was approved by the Institutional Review Board fulfilling all of the requirements for retrospective
               studies in humans, according to the guidelines of the 1975 Helsinki Declaration.


               Copyright
               © The Author(s) 2018.



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