A Point System to Forecast Hepatocellular Carcinoma Risk Before and After Treatment Among Persons with Chronic Hepatitis C

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Digestive diseases and sciences


BACKGROUND: Risk of hepatocellular carcinoma (HCC) may be difficult to determine in the clinical setting.

AIM: Develop a scoring system to forecast HCC risk among patients with chronic hepatitis C.

METHODS: Using data from the Chronic Hepatitis Cohort Study collected during 2005-2014, we derived HCC risk scores for males and females using an extended Cox model with aspartate aminotransferase-to-platelet ratio index (APRI) as a time-dependent variables and mean Kaplan-Meier survival functions from patient data at two study sites, and used data collected at two separate sites for external validation. For model calibration, we used the Greenwood-Nam-D'Agostino goodness-of-fit statistic to examine differences between predicted and observed risk.

RESULTS: Of 12,469 patients (1628 with a history of sustained viral response [SVR]), 504 developed HCC; median follow-up was 6 years. Final predictors in the model included age, alcohol abuse, interferon-based treatment response, and APRI. Point values, ranging from -3 to 14 (males) and -3 to 12 (females), were established using hazard ratios of the predictors aligned with 1-, 3-, and 5-year Kaplan-Meier survival probabilities of HCC. Discriminatory capacity was high (c-index 0.82 males and 0.84 females) and external calibration demonstrated no differences between predicted and observed HCC risk for 1-, 3-, and 5-year forecasts among males (all p values >0.97) and for 3- and 5-year risk among females (all p values >0.87).

CONCLUSION: This scoring system, based on age, alcohol abuse history, treatment response, and APRI, can be used to forecast up to a 5-year risk of HCC among hepatitis C patients before and after SVR.

Medical Subject Headings

Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Aspartate Aminotransferases; Biomarkers; Blood Platelets; Carcinoma, Hepatocellular; Clinical Enzyme Tests; Decision Support Techniques; Hepatitis C, Chronic; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Middle Aged; Platelet Count; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Reproducibility of Results; Risk Assessment; Risk Factors; Time Factors; United States; Young Adult

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