State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
J Hepatol. 2020 Dec;73(6):1368-1378. doi: 10.1016/j.jhep.2020.07.025. Epub 2020 Jul 21.
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for patients with chronic hepatitis.
A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686).
We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, male, albumin-bilirubin and platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies, but also in those with different ethnicities (C-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (n = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%.
This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide.
In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin-bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.
肝细胞癌（HCC）是慢性肝炎患者死亡的主要原因。在这项国际合作中，我们旨在开发一种全球通用的 HCC 风险评分，以预测慢性肝炎患者的 HCC 发展。
共纳入来自 11 项国际前瞻性观察性队列或随机对照试验的 17374 例患者，包括 10578 例接受慢性乙型肝炎（CHB）治疗的亚洲患者、2510 例接受慢性乙型肝炎治疗的白种人患者、3566 例接受丙型肝炎病毒治疗的患者（包括 2489 例肝硬化患者实现持续病毒学应答）和 720 例非病毒性肝炎（NVH）患者。将患者分为训练队列（3688 例接受慢性乙型肝炎治疗的亚洲患者）和 9 个验证队列，这些队列具有不同的病因和种族（n=13686）。
我们开发了一种 HCC 风险评分，称为 aMAP 评分（范围为 0 到 100），仅涉及年龄、性别、白蛋白-胆红素和血小板。该指标在评估不同病因和不同种族的患者的 HCC 风险方面表现出色（C 指数：0.82-0.87）。50 和 60 的截断值最适合区分 HCC 风险。低风险组（n=7413，43.6%）、中风险组（n=6529，38.4%）和高风险组（n=3044，17.9%）的 3 年和 5 年 HCC 累积发生率分别为 0-0.8%、1.5-4.8%和 8.1-19.9%。50 的截断值与 85.7-100%的敏感性和 99.3-100%的阴性预测值相关。60 的截断值导致 56.6-95.8%的特异性和 6.6-15.7%的阳性预测值。
该基于 5 个常见参数的客观、简单、可靠的风险评分准确预测 HCC 发生，与病因和种族无关，有助于在全球范围内建立基于风险评分的 HCC 监测策略。
在这项国际合作中，我们开发并外部验证了一种简单、客观和准确的预后工具（称为 aMAP 评分），仅涉及年龄、性别、白蛋白-胆红素和血小板。aMAP 评分（范围为 0 到 100）在来自 11 项全球前瞻性研究的 17374 例病毒性和非病毒性肝炎患者中，令人满意地预测了肝细胞癌（HCC）的发生风险。我们的研究结果表明，无论病因和种族如何，aMAP 评分在评估所有队列的 5 年 HCC 风险方面均具有出色的区分度和校准度。
