Xing Jian, Spradling Philip R, Moorman Anne C, Holmberg Scott D, Teshale Eyasu H, Rupp Loralee B, Gordon Stuart C, Lu Mei, Boscarino Joseph A, Schmidt Mark A, Trinacty Connie M, Xu Fujie
Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Mailstop G37, 1600 Clifton Road NE, Atlanta, GA, 30333, USA.
Henry Ford Health System, Detroit, MI, USA.
Dig Dis Sci. 2017 Nov;62(11):3221-3234. doi: 10.1007/s10620-017-4762-0. Epub 2017 Sep 30.
Risk of hepatocellular carcinoma (HCC) may be difficult to determine in the clinical setting.
Develop a scoring system to forecast HCC risk among patients with chronic hepatitis C.
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.
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).
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.
在临床环境中，肝细胞癌（HCC）的风险可能难以确定。
开发一种评分系统，以预测慢性丙型肝炎患者的HCC风险。
利用2005年至2014年期间收集的慢性丙型肝炎队列研究数据，我们使用扩展的Cox模型，将天冬氨酸转氨酶与血小板比值指数（APRI）作为时间依赖变量，并根据两个研究地点患者数据的平均Kaplan-Meier生存函数，得出男性和女性的HCC风险评分，并使用在两个独立地点收集的数据进行外部验证。为了进行模型校准，我们使用Greenwood-Nam-D'Agostino拟合优度统计量来检验预测风险与观察到的风险之间的差异。
在12469例患者中（1628例有持续病毒学应答[SVR]史），504例发生了HCC；中位随访时间为6年。模型中的最终预测因素包括年龄、酗酒、基于干扰素的治疗反应和APRI。根据预测因素的风险比与HCC的1年、3年和5年Kaplan-Meier生存概率对齐，确定了-3至14（男性）和-3至12（女性）的分值。判别能力较高（男性c指数为0.82，女性为0.84），外部校准表明，男性1年、3年和5年预测的HCC风险以及女性3年和5年风险的预测值与观察值之间无差异（所有p值>0.97）（女性所有p值>0.87）。
该评分系统基于年龄、酗酒史、治疗反应和APRI，可用于预测SVR前后丙型肝炎患者长达5年的HCC风险。
