Sharma Suraj A, Kowgier Matthew, Hansen Bettina E, Brouwer Willem Pieter, Maan Raoel, Wong David, Shah Hemant, Khalili Korosh, Yim Colina, Heathcote E Jenny, Janssen Harry L A, Sherman Morris, Hirschfield Gideon M, Feld Jordan J
Toronto Centre for Liver Disease, University Health Network, University of Toronto, Canada.
Toronto Centre for Liver Disease, University Health Network, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
J Hepatol. 2017 Aug 24. doi: 10.1016/j.jhep.2017.07.033.
BACKGROUND & AIMS: Current guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in all patients with cirrhosis, regardless of etiology. However, HCC incidence is not well established for many causes of cirrhosis. We aimed to assess the disease-specific incidence of HCC in a large cohort of patients with cirrhosis and to develop a scoring system to predict HCC risk.
A derivation cohort of patients with cirrhosis diagnosed by biopsy or non-invasive measures was identified through retrospective chart review. The disease-specific incidence of HCC was calculated according to etiology of cirrhosis. Factors associated with HCC were identified through multivariable Cox regression and used to develop a scoring system to predict HCC risk. The scoring system was evaluated in an external cohort for validation.
Of 2,079 patients with cirrhosis and ≥6months follow-up, 226 (10.8%) developed HCC. The 10-year cumulative incidence of HCC varied by etiologic category from 22% in patients with viral hepatitis, to 16% in those with steatohepatitis and 5% in those with autoimmune liver disease (p<0.001). By multivariable Cox regression, age, sex, etiology and platelets were associated with HCC. Points were assigned in proportion to each hazard ratio to create the Toronto HCC Risk Index (THRI). The 10-year cumulative HCC incidence was 3%, 10% and 32% in the low-risk (<120points), medium-risk (120-240) and high-risk (>240) groups respectively, values that remained consistent after internal validation. External validation was performed on a cohort of patients with primary biliary cirrhosis, hepatitis B viral and hepatitis C viral cirrhosis (n=1,144), with similar predictive ability (Harrell's c statistic 0.77) in the validation and derivation cohorts.
HCC incidence varies markedly by etiology of cirrhosis. The THRI, using readily available clinical and laboratory parameters, has good predictive ability for HCC in patients with cirrhosis, and has been validated in an external cohort. This risk score may help to guide recommendations regarding HCC surveillance among patients with cirrhosis.
HCC incidence varies markedly depending on the underlying cause of cirrhosis. Herein, using readily available clinical and laboratory parameters we describe a risk score, THRI, which has a good predictive ability for HCC in patients with cirrhosis, and has been validated in an external cohort. This risk score may help to guide recommendations regarding HCC surveillance among patients with cirrhosis.
当前指南建议对所有肝硬化患者每半年进行一次肝细胞癌（HCC）监测，无论其病因如何。然而，许多病因导致的肝硬化患者的HCC发病率尚未明确。我们旨在评估一大群肝硬化患者中特定疾病的HCC发病率，并开发一种评分系统来预测HCC风险。
通过回顾性病历审查确定了一组经活检或非侵入性检查诊断为肝硬化的患者作为推导队列。根据肝硬化病因计算HCC的特定疾病发病率。通过多变量Cox回归确定与HCC相关的因素，并用于开发预测HCC风险的评分系统。在外部队列中对该评分系统进行评估以验证其有效性。
在2079例肝硬化患者中，随访时间≥6个月，226例（10.8%）发生了HCC。HCC的10年累积发病率因病因类别而异，病毒性肝炎患者为22%，脂肪性肝炎患者为16%，自身免疫性肝病患者为5%（p<0.001）。通过多变量Cox回归分析，年龄、性别、病因和血小板与HCC相关。根据每个风险比按比例分配分值，创建了多伦多HCC风险指数（THRI）。低风险（<120分）、中风险（120 - 240分）和高风险（>240分）组的10年累积HCC发病率分别为3%、10%和32%，内部验证后这些值保持一致。在一组原发性胆汁性肝硬化、乙型肝炎病毒和丙型肝炎病毒肝硬化患者（n = 1144）中进行了外部验证，在验证队列和推导队列中具有相似的预测能力（Harrell's c统计量为0.77）。
HCC发病率因肝硬化病因不同而有显著差异。THRI使用易于获得的临床和实验室参数，对肝硬化患者的HCC具有良好的预测能力，并已在外部队列中得到验证。该风险评分可能有助于指导关于肝硬化患者HCC监测的建议。
HCC发病率因肝硬化的潜在病因不同而有显著差异。在此，我们使用易于获得的临床和实验室参数描述了一种风险评分THRI，它对肝硬化患者的HCC具有良好的预测能力，并已在外部队列中得到验证。该风险评分可能有助于指导关于肝硬化患者HCC监测的建议。
