MethodsA total of 17,374 patients, comprising 10,578 treated Asian chronic hepatitis B (CHB)patients, 2510 treated Caucasian CHB patients, 3566 treated hepatitis C virus(HCV)-infected patients (including 2489 patients with cirrhosis achieving a sustainedvirologic response) and 720 non-viral hepatitis (NVH) patients from 11 internationalprospective observational cohorts or randomized controlled trials, were divided into atraining cohort (3688 Asian CHB patients) and 9 validation cohorts with differentaetiologies and ethnicities (N =13,686).
ResultsWe developed an HCC risk score, called the aMAP score (ranging from 0 to 100), thatinvolves only age, Male, Albumin-bilirubin and Platelets. This metric performedexcellently in assessing HCC risk not only in patients with hepatitis of differentaetiologies but also in those with different ethnicities (c-index: 0.82-0.87). Cut-off valuesof 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulativeincidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (N=7413, 43.6%),medium- (N=6529, 38.4%), and high-risk (N =3044, 17.9%) groups, respectively. Thecut-off value of 50 was associated with a sensitivity of 85.7-100% and a negativepredictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of56.6-95.8% and a positive predictive value of 6.6-15.7%.
ConclusionsThis objective, simple, reliable risk score based on five common parameters accuratelypredicts HCC development, regardless of aetiology and ethnicity, which may help toestablish a risk score-guided HCC surveillance strategy worldwide.
- hepatocellular carcinoma; risk score; hepatitis B virus; hepatitis C virus; non-alcoholic fatty liver disease