Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea.
Department of Biostatistics, Korea University, Seoul, Republic of Korea.
Liver Int. 2024 Mar;44(3):738-748. doi: 10.1111/liv.15819. Epub 2023 Dec 18.
BACKGROUND & AIMS: Although non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of hepatocellular carcinoma (HCC), HCC risk in non-cirrhotic NAFLD received little attention. We aimed to develop and validate an HCC risk prediction model for non-cirrhotic NAFLD.
A nationwide cohort of non-cirrhotic NAFLD patients in Korea was recruited to develop a risk prediction model and validate it internally (n = 409 088). A model using a simplified point system was developed by Cox proportional hazard model. K-fold cross-validation assessed the accuracy, discrimination and calibration. The model was validated externally using a hospital cohort from Asan Medical Center (n = 8721).
An 11-point HCC risk prediction model for non-cirrhotic NAFLD was developed using six independent factors of age, sex, diabetes, obesity, serum alanine aminotransferase level and gamma-glutamyl transferase level (c-index 0.75). The average area under receiver operating curves (AUROCs) of the model was 0.72 at 5 years and 0.75 at 10 years. In the external validation cohort, the AUROCs were 0.79 [95% confidence interval [CI], 0.59-0.95] at 5 years and 0.84 (95% CI, 0.73-0.94) at 10 years. The calibration plots showed the expected risks corresponded well with the observed risks. Risk stratification categorized patients into the low (score 0-6), moderate (7, 8) and high (9-11; estimated incidence rate >0.2%/year) risk groups.
A novel HCC risk prediction model for non-cirrhotic NAFLD patients was developed and validated with fair performance. The model is expected to serve as a simple and reliable tool to assess HCC risk and assist precision screening of HCC.
尽管非酒精性脂肪性肝病（NAFLD）正在成为肝细胞癌（HCC）的主要病因，但非肝硬化性 NAFLD 的 HCC 风险却很少受到关注。我们旨在为非肝硬化性 NAFLD 患者开发和验证 HCC 风险预测模型。
在韩国招募了一个全国性的非肝硬化性 NAFLD 患者队列，用于开发风险预测模型并进行内部验证（n=409088）。使用 Cox 比例风险模型开发了一种简化的点系统模型。K 折交叉验证评估了准确性、区分度和校准度。该模型使用 Asan 医疗中心的医院队列进行外部验证（n=8721）。
我们开发了一个针对非肝硬化性 NAFLD 的 11 分 HCC 风险预测模型，该模型使用了年龄、性别、糖尿病、肥胖、血清丙氨酸氨基转移酶水平和γ-谷氨酰转移酶水平等 6 个独立因素（c 指数为 0.75）。模型的平均 5 年和 10 年的接收器工作曲线下面积（AUROCs）分别为 0.72 和 0.75。在外部验证队列中，5 年和 10 年的 AUROCs 分别为 0.79（95%置信区间 [CI]，0.59-0.95）和 0.84（95%CI，0.73-0.94）。校准图显示，预期风险与观察风险吻合良好。风险分层将患者分为低（评分 0-6）、中（7、8）和高（9-11；估计发生率>0.2%/年）风险组。
我们开发并验证了一种针对非肝硬化性 NAFLD 患者的新型 HCC 风险预测模型，该模型具有良好的性能。该模型有望成为评估 HCC 风险和辅助 HCC 精准筛查的简单可靠工具。
