Comparing predicted probability of hepatocellular carcinoma in cirrhosis patients to the general population: an opportunity to improve risk communication?

Hamish Innes, Victoria Hamill, Scott McDonald, Peter Hayes, Philip Johnson, John Dillon, Jen Bishop, Alan Yeung, April Went, Stephen Barclay, Andrew Fraser, Andrew Bathgate, David Goldberg, Sharon Hutchinson

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND:
Risk scores estimating a patient’s probability of a hepatocellular carcinoma (HCC) diagnosis are abundant, but are difficult to interpret in isolation. Here, we compared the predicted HCC probability for individuals with cirrhosis and cured hepatitis C to the general population (GP).

METHODS:
All patients with cirrhosis achieving sustained viral response (SVR) in Scotland by April 2018 were included (N=1803). The predicted three-year probability of HCC at time of SVR achievement was determined using the aMAP prognostic model. GP data on the total number of incident HCCs in Scotland, stratified by demographics, were obtained from Public Health Scotland.

Predicted HCC risk for cirrhosis SVR patients was compared to GP incidence using two metrics: 1) Incidence ratio: i.e. three-year predicted probability for a given patient divided by the three-year probability in GP for the equivalent demographic group; and 2) Absolute risk difference: the three-year predicted probability minus the three-year probability in the GP).

RESULTS:
The mean predicted three-year HCC probability among cirrhosis SVR patients was 3.64% (range: 0.012%-36.12%). Conversely, the three-year HCC probability in the GP was much lower, ranging from 10,000. The mean absolute risk difference was 3.61%, ranging from 0.012 to 35.9%. An online HCC-GP comparison calculator for use by patients/clinicians is available at: https://thrive-svr.shinyapps.io/RShiny/Comparing a patient’s predicted HCC probability to the general population is feasible and may help clinicians communicate risk information and encourage screening uptake.

Original languageEnglish
JournalAmerican journal of gastroenterology
Early online date24 Jun 2022
DOIs
Publication statusE-pub ahead of print - 24 Jun 2022

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