P-154 Using the EVendo score to predict varices and varices needing treatment in hepatocellular carcinoma patients planned for atezolizumab-bevacizumab

Combination Atezolizumab-Bevacizumab (AB) is the current standard of care first-line treatment for patients with advanced hepatocellular carcinoma (HCC). Bevacizumab associated increased risk gastrointestinal bleeding, a concern especially pertinent this group patients. IMBrave150 hence mandated esophago-gastroduodenoscopy (OGD) within 6 months therapy initiation, allowing existing gastroesophageal varices (GEV). Universal pre-treatment OGD can be challenging, potentially delaying initiation. Non-invasive scores have been developed to stratify cirrhotic variceal screening. The EVendo Score, validated score derived from readily available laboratory and clinical data, was using machine-learning algorithm. A cutoff ≤3.90 found high specificity sensitivity in identification no VNT which could deferred. has not tested HCC planned AB We retrospectively analysed data 90 treated at National Cancer Centre (Singapore) June 2018-July 2022. Patients on dialysis or anticoagulation were excluded. Biochemical collected included hemoglobin, international normalized ratio, aspartate transaminase, albumin, platelet count, blood urea nitrogen. Clinical parameters presence/absence ascites, endoscopic findings including varices, type grade high-risk features, management bleeding sequelae. Varices needing (VNT) defined as presence ≥2 EV, EV any size stigmata, gastric varices. calculated each patient, based cut-offs ≤4.50, sensitivity, specificity, positive predictive value (PPV) NPV calculated. 64 analysis. In 37 (57.8%) who had an ≤3.90, 10 (27%) GEV endoscopy 5 (13.5%) VNT. An identified without sensitivities 68% (95 CI 51-81) 58% (95% 37-78) specificities 44% 14-79) respectively. also used another cut off ≤4.50; 47 (73.4%) 15 (31.9%) 4 (8.5%) ≤4.5 80% 64-91) 75% CI, 61-85), 38% 19-59) 33% 7-70) absence study cohort 86% 71-95). With more stringent significantly improved 87% 74-95). When applied both pre-existing cirrhosis HCC, low moderately however lower than original development subsequent validations (ranging 94-100%), suggesting still significant missed Higher incorporation other radiological determine should further evaluated.