aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis

Rong Fan, George Papatheodoridis, Jian Sun, Hamish Innes, Hidenori Toyoda, Qing Xie, Shuyuan Mo, Vana Sypsa , Indra Neil Guha, Takashi Kumada, Junqi Niu, George Dalekos, Satoshi Yasuda, Eleanor Barnes, Jianqi Lian, Vithika Suri, Ramazan Idilman, Stephen T. Barclay, Xiaoguang Dou, Thomas BergPeter C. Hayes, John F. Flaherty, Yuanping Zhou, Zhengang Zhang, Maria Buti, Sharon J. Hutchinson, Yabing Guo, Jose Luis Calleja, Lanjia Lin, Longfeng Zhao, Yongpeng Chen, Harry LA. Janssen, Chaonan Zhu, Lei Shi, Xiaoping Tang, Anuj Gaggar, Lai Wei, Jidong Jia, William L. Irving, Philip J. Johnson*, Pietro Lampertico*, Jinlin Hou*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Citations (Scopus)
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AbstractBackground & Aims

Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for chronic hepatitis patients.


A 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 sustained virologic response) and 720 non-viral hepatitis (NVH) patients from 11 international prospective observational cohorts or randomized controlled trials, were divided into a training cohort (3688 Asian CHB patients) and 9 validation cohorts with different aetiologies and ethnicities (N =13,686).


We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, Male, Albumin-bilirubin and Platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies but also in those with different ethnicities (c-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences 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. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%.


This objective, simple, reliable risk score based on five common parameters accurately predicts HCC development, regardless of aetiology and ethnicity, which may help to establish a risk score-guided HCC surveillance strategy worldwide.

Original languageEnglish
Pages (from-to)1368-1378
JournalJournal of Hepatology
Issue number6
Early online date20 Jul 2020
Publication statusPublished - 1 Dec 2020


  • hepatocellular carcinoma; risk score; hepatitis B virus; hepatitis C virus; non-alcoholic fatty liver disease


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