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 Berg; Peter 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

doi:10.1016/j.jhep.2020.07.025

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

SHLS School Office

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Abstract

Background & 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 patients with chronic hepatitis. Methods: A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). Results: 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 = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 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%. Conclusions: This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. Lay summary: In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin–bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.

Original language	English
Pages (from-to)	1368-1378
Number of pages	11
Journal	Journal of Hepatology
Volume	73
Issue number	6
Early online date	20 Jul 2020
DOIs	https://doi.org/10.1016/j.jhep.2020.07.025
Publication status	Published - 1 Dec 2020

Keywords

hepatocellular carcinoma; risk score; hepatitis B virus; hepatitis C virus; non-alcoholic fatty liver disease
HCC
Risk score
Hepatitis B virus
Hepatitis C virus
Non-alcoholic fatty liver disease

ASJC Scopus subject areas

Hepatology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jhep.2020.07.025

Fan, R. et al (2020) aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitisin chronic hepatitis patients an international cohort collaboration
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is the accepted author manuscript of the article due to be published in final form as an open access article under the Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) license.
Author accepted manuscript, 2.36 MBLicence: CC BY-NC-ND
Fan, R. et al (2020) aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). J. Hepatol. 2020, 73, 1368–1378
Final published version, 890 KBLicence: CC BY-NC-ND

Cite this

Fan, R., Papatheodoridis, G., Sun, J., Innes, H., Toyoda, H., Xie, Q., Mo, S., Sypsa , V., Guha, I. N., Kumada, T., Niu, J., Dalekos, G., Yasuda, S., Barnes, E., Lian, J., Suri, V., Idilman, R., Barclay, S. T., Dou, X., ... Hou, J. (2020). aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. Journal of Hepatology, 73(6), 1368-1378. https://doi.org/10.1016/j.jhep.2020.07.025

@article{e3bf5dc2118d4d8ea37d6b7447f0adff,

title = "aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis",

abstract = "Background & 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 patients with chronic hepatitis. Methods: A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). Results: 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 = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 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%. Conclusions: This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. Lay summary: In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin–bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.",

keywords = "hepatocellular carcinoma; risk score; hepatitis B virus; hepatitis C virus; non-alcoholic fatty liver disease, HCC, Risk score, Hepatitis B virus, Hepatitis C virus, Non-alcoholic fatty liver disease",

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

note = "Acceptance from webpage Due to be published OA (from publisher website) but only early version available at time of checking 28/07/20 ST AAM: made open as open access status confirmed on publisher webpage. ET 2/9/20 Acceptance from webpage Retained AAM for compliance - VoR is published under CC-BY-NC-ND and doesn't meet our Gold OA definition. ET 18/12/20 ",

year = "2020",

month = dec,

day = "1",

doi = "10.1016/j.jhep.2020.07.025",

language = "English",

volume = "73",

pages = "1368--1378",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier B.V.",

number = "6",

}

Fan, R, Papatheodoridis, G, Sun, J, Innes, H, Toyoda, H, Xie, Q, Mo, S, Sypsa , V, Guha, IN, Kumada, T, Niu, J, Dalekos, G, Yasuda, S, Barnes, E, Lian, J, Suri, V, Idilman, R, Barclay, ST, Dou, X, Berg, T, Hayes, PC, Flaherty, JF, Zhou, Y, Zhang, Z, Buti, M, Hutchinson, SJ, Guo, Y, Calleja, JL, Lin, L, Zhao, L, Chen, Y, Janssen, HLA, Zhu, C, Shi, L, Tang, X, Gaggar, A, Wei, L, Jia, J, Irving, WL, Johnson, PJ, Lampertico, P & Hou, J 2020, 'aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis', Journal of Hepatology, vol. 73, no. 6, pp. 1368-1378. https://doi.org/10.1016/j.jhep.2020.07.025

TY - JOUR

T1 - aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis

AU - Fan, Rong

AU - Papatheodoridis, George

AU - Sun, Jian

AU - Innes, Hamish

AU - Toyoda, Hidenori

AU - Xie, Qing

AU - Mo, Shuyuan

AU - Sypsa , Vana

AU - Guha, Indra Neil

AU - Kumada, Takashi

AU - Niu, Junqi

AU - Dalekos, George

AU - Yasuda, Satoshi

AU - Barnes, Eleanor

AU - Lian, Jianqi

AU - Suri, Vithika

AU - Idilman, Ramazan

AU - Barclay, Stephen T.

AU - Dou, Xiaoguang

AU - Berg, Thomas

AU - Hayes, Peter C.

AU - Flaherty, John F.

AU - Zhou, Yuanping

AU - Zhang, Zhengang

AU - Buti, Maria

AU - Hutchinson, Sharon J.

AU - Guo, Yabing

AU - Calleja, Jose Luis

AU - Lin, Lanjia

AU - Zhao, Longfeng

AU - Chen, Yongpeng

AU - Janssen, Harry LA.

AU - Zhu, Chaonan

AU - Shi, Lei

AU - Tang, Xiaoping

AU - Gaggar, Anuj

AU - Wei, Lai

AU - Jia, Jidong

AU - Irving, William L.

AU - Johnson, Philip J.

AU - Lampertico, Pietro

AU - Hou, Jinlin

N1 - Acceptance from webpage Due to be published OA (from publisher website) but only early version available at time of checking 28/07/20 ST AAM: made open as open access status confirmed on publisher webpage. ET 2/9/20 Acceptance from webpage Retained AAM for compliance - VoR is published under CC-BY-NC-ND and doesn't meet our Gold OA definition. ET 18/12/20

PY - 2020/12/1

Y1 - 2020/12/1

N2 - Background & 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 patients with chronic hepatitis. Methods: A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). Results: 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 = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 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%. Conclusions: This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. Lay summary: In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin–bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.

AB - Background & 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 patients with chronic hepatitis. Methods: A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). Results: 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 = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 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%. Conclusions: This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. Lay summary: In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin–bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.

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

KW - HCC

KW - Risk score

KW - Hepatitis B virus

KW - Hepatitis C virus

KW - Non-alcoholic fatty liver disease

U2 - 10.1016/j.jhep.2020.07.025

DO - 10.1016/j.jhep.2020.07.025

M3 - Article

SN - 0168-8278

VL - 73

SP - 1368

EP - 1378

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 6

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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