Innes Hamish, Johnson Philip, McDonald Scott A, Hamill Victoria, Yeung Alan, Dillon John F, Hayes Peter C, Went April, Barclay Stephen T, Fraser Andrew, Bathgate Andrew, Goldberg David J, Hutchinson Sharon J
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Public Health Scotland, Glasgow, UK.
Gastro Hep Adv. 2022 Feb 3;1(2):129-136. doi: 10.1016/j.gastha.2021.11.008. eCollection 2022.
Existing models predicting hepatocellular carcinoma (HCC) occurrence do not account for competing risk events and, thus, may overestimate the probability of HCC. Our goal was to quantify this bias for patients with cirrhosis and cured hepatitis C.
We analyzed a nationwide cohort of patients with cirrhosis and cured hepatitis C infection from Scotland. Two HCC prognostic models were developed: (1) a Cox regression model ignoring competing risk events and (2) a Fine-Gray regression model accounting for non-HCC mortality as a competing risk. Both models included the same set of prognostic factors used by previously developed HCC prognostic models. Two predictions were calculated for each patient: first, the 3-year probability of HCC predicted by model 1 and second, the 3-year probability of HCC predicted by model 2.
The study population comprised 1629 patients with cirrhosis and cured HCV, followed for 3.8 years on average. A total of 82 incident HCC events and 159 competing risk events (ie, non-HCC deaths) were observed. The mean predicted 3-year probability of HCC was 3.37% for model 1 (Cox) and 3.24% for model 2 (Fine-Gray). For most patients (76%), the difference in the 3-year probability of HCC predicted by model 1 and model 2 was minimal (ie, within 0 to ±0.3%). A total of 2.6% of patients had a large discrepancy exceeding 2%; however, these were all patients with a 3-year probability exceeding >5% in both models.
Prognostic models that ignore competing risks do overestimate the future probability of developing HCC. However, the degree of overestimation-and the way it is patterned-means that the impact on HCC screening decisions is likely to be modest.
现有的预测肝细胞癌（HCC）发生的模型未考虑竞争风险事件，因此可能高估了HCC的发生概率。我们的目标是量化肝硬化和丙型肝炎治愈患者的这种偏差。
我们分析了来自苏格兰的全国性肝硬化和丙型肝炎治愈感染患者队列。开发了两种HCC预后模型：（1）忽略竞争风险事件的Cox回归模型，以及（2）将非HCC死亡率作为竞争风险考虑在内的Fine-Gray回归模型。两种模型都包括先前开发的HCC预后模型所使用的相同一组预后因素。为每位患者计算了两个预测值：第一，模型1预测的3年HCC发生概率；第二，模型2预测的3年HCC发生概率。
研究人群包括1629例肝硬化和HCV治愈患者，平均随访3.8年。共观察到82例HCC发病事件和159例竞争风险事件（即非HCC死亡）。模型1（Cox）预测的3年HCC平均发生概率为3.37%，模型2（Fine-Gray）为3.24%。对于大多数患者（76%），模型1和模型2预测的3年HCC发生概率差异极小（即0至±0.3%以内）。共有2.6%的患者差异超过2%；然而，这些患者在两种模型中的3年发生概率均超过5%。
忽略竞争风险的预后模型确实高估了未来发生HCC的概率。然而，高估的程度及其模式表明，对HCC筛查决策的影响可能不大。
