Caviglia Gian Paolo, Troshina Giulia, Santaniello Umberto, Rosati Giulia, Bombaci Francesco, Birolo Giovanni, Nicolosi Aurora, Saracco Giorgio Maria, Ciancio Alessia
Liver Unit, Department of Medical Sciences, University of Torino, 10126 Turin, Italy.
Gastroenterology Unit, Department of General and Specialistic Medicine, A.O.U. Città della Salute e della Scienza-Molinette Hospital, 10126 Turin, Italy.
Cancers (Basel). 2022 Feb 6;14(3):828. doi: 10.3390/cancers14030828.
Patients with hepatitis C virus (HCV)-related cirrhosis treated with direct-acting antivirals (DAA) are still at risk of developing hepatocellular carcinoma (HCC). We investigated the accuracy of non-invasive scoring systems (NSS) for the prediction of de novo HCC development in patients treated with DAA on long-term follow-up (FU). We analyzed data from 575 consecutive patients with cirrhosis and no history of HCC who achieved a sustained virologic response (SVR) to DAA therapy. NSS (i.e., Forns index, APRI, FIB-4, ALBI, and aMAP) were calculated at 3 months after the end of therapy. Performance for de novo HCC prediction was evaluated in terms of area under the curve (AUC) and Harrell's C-index. During a median FU of 44.9 (27.8-58.6) months, 57 (9.9%) patients developed de novo HCC. All five NSS were associated with the risk of de novo HCC. At multivariate analysis, only the ALBI score resulted in being significantly and independently associated with de novo HCC development (adjusted hazard ratio = 4.91, 95% CI 2.91-8.28, < 0.001). ALBI showed the highest diagnostic accuracy for the detection of de novo HCC at 1-, 3-, and 5-years of FU, with AUC values of 0.81 (95% CI 0.78-0.85), 0.71 (95% CI 0.66-0.75), and 0.68 (95% CI 0.59-0.76), respectively. Consistently, the best predictive performance assessed by Harrell's C-statistic was observed for ALBI (C-index = 0.70, 95% CI 0.62-0.77). ALBI score may represent a valuable and inexpensive tool for risk stratification and the personalization of an HCC surveillance strategy for patients with cirrhosis and previous history of HCV infection treated with DAA.
接受直接作用抗病毒药物（DAA）治疗的丙型肝炎病毒（HCV）相关肝硬化患者仍有发生肝细胞癌（HCC）的风险。我们研究了非侵入性评分系统（NSS）在长期随访（FU）中预测接受DAA治疗患者新发HCC的准确性。我们分析了575例连续的肝硬化患者的数据，这些患者无HCC病史，且对DAA治疗实现了持续病毒学应答（SVR）。在治疗结束后3个月计算NSS（即Forns指数、APRI、FIB-4、ALBI和aMAP）。根据曲线下面积（AUC）和Harrell's C指数评估新发HCC预测的性能。在中位随访44.9（27.8 - 58.6）个月期间，57例（9.9%）患者发生了新发HCC。所有五个NSS均与新发HCC风险相关。在多变量分析中，只有ALBI评分与新发HCC的发生显著且独立相关（调整后的风险比 = 4.91，95% CI 2.91 - 8.28，< 0.001）。在随访1年、3年和5年时，ALBI对新发HCC检测的诊断准确性最高，AUC值分别为0.81（95% CI 0.78 - 0.85）、0.71（95% CI 0.66 - 0.75）和0.68（95% CI 0.59 - 0.76）。同样，通过Harrell's C统计量评估的最佳预测性能在ALBI中观察到（C指数 = 0.70，95% CI 0.62 - 0.77）。对于接受DAA治疗的有HCV感染既往史的肝硬化患者，ALBI评分可能是一种有价值且廉价的工具，用于风险分层和HCC监测策略的个体化。
