Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Gut. 2016 Aug;65(8):1347-58. doi: 10.1136/gutjnl-2014-309099. Epub 2015 Apr 30.
Patients with chronic hepatitis B (CHB) infection are at an increased risk of developing hepatocellular carcinoma (HCC). Risk scores have been developed in Asian populations to predict HCC risk over time.
To assess the performance of HCC risk prediction models in a heterogeneous population of patients with CHB.
Scores were calculated at baseline using CU-HCC, REACH-B, NGM1-HCC, NGM2-HCC and GAG-HCC models and the incidence of HCC was determined. The predictive ability of each score was evaluated using the area under the receiver operating characteristic curve (AUROC), Cox regression and plots of observed versus predicted HCC. The predictive value of the scores was compared between Asian and non-Asian patients and between cirrhotic versus non-cirrhotic with and without treatment.
Of 2105 patients, 70 developed HCC. Increasing risk score was associated with HCC in all models. The CU-HCC model had the highest AUROC in Asian (0.85) and non-Asian (0.91) patients. Patients identified as low risk by any model had a very low incidence of HCC (0-0.15 per year), with the highest proportion of patients identified as low risk using CU-HCC (67%) or GAG-HCC (78%). The risk of HCC was similar to predicted for low-risk and medium-risk patients but was lower than predicted for high-risk patients. Treated patients had a lower than predicted risk of HCC, particularly in non-cirrhotic high-risk patients with longer follow-up.
Although all models predicted the risk of HCC, models that incorporated parameters of liver function or cirrhosis (CU-HCC/GAG-HCC) were most accurate. Low-risk patients likely require reduced HCC surveillance.
慢性乙型肝炎（CHB）感染患者发生肝细胞癌（HCC）的风险增加。亚洲人群已经开发了风险评分来预测 HCC 的风险。
评估 HCC 风险预测模型在 CHB 患者异质人群中的表现。
使用 CU-HCC、REACH-B、NGM1-HCC、NGM2-HCC 和 GAG-HCC 模型在基线时计算评分，并确定 HCC 的发生率。使用接受者操作特征曲线下面积（AUROC）、Cox 回归和观察到的 HCC 与预测 HCC 的图评估每个评分的预测能力。比较了亚洲和非亚洲患者、肝硬化和非肝硬化患者以及有和无治疗患者之间评分的预测价值。
在 2105 名患者中，有 70 名发生 HCC。在所有模型中，风险评分增加与 HCC 相关。CU-HCC 模型在亚洲（0.85）和非亚洲（0.91）患者中的 AUROC 最高。任何模型均被识别为低风险的患者 HCC 发生率非常低（0-0.15 年/年），其中 CU-HCC（67%）或 GAG-HCC（78%）识别为低风险的患者比例最高。低风险和中风险患者的 HCC 风险与预测相符，但高风险患者的 HCC 风险低于预测。治疗患者的 HCC 风险低于预测，尤其是在肝硬化和非肝硬化的高危患者中，随访时间更长。
虽然所有模型都预测了 HCC 的风险，但包含肝功能或肝硬化参数的模型（CU-HCC/GAG-HCC）最准确。低风险患者可能需要减少 HCC 监测。
