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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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