Document Type

Article

Publication Date

11-1-2017

Publication Title

Digestive diseases and sciences

Abstract

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

PubMed ID

28965221

Volume

62

Issue

11

First Page

3221

Last Page

3234

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.