Shiha Gamal, Hassan Ayman, Mousa Nasser, El-Domiaty Nada, Mikhail Nabiel, Gameaa Reham, Kobtan Abdelrahman, El Bassat Hanan, Sharaf-Eldin Mohamed, Waked Imam, Eslam Mohamed, Soliman Riham
Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
Aliment Pharmacol Ther. 2025 Jan;61(1):99-108. doi: 10.1111/apt.18291. Epub 2024 Sep 23.
Several HCC risk stratification scores were developed; however, none has been prospectively validated. The primary aim is to validate the clinical utility of six HCC risk scores in large prospective study of F3-4 patients achieving SVR following DAAs according to EASL guidelines. The secondary aim is to explore whether individualized risk stratification improves detection of HCC at early stages amenable to curative treatment.
This prospective study included two cohorts: Egyptian Liver Research Institute and Hospital (ELRIAH) cohort of 463 chronic HCV patients with advanced liver disease (F3 and F4) achieved SVR with a follow-up every 6 months according to EASL guidelines using 6 simple HCC risk scores and Tanta cohort of 492 comparable patients where individualized surveillance intervals were tailored based on HCC risk assessments using GES score as follows: low-risk patients were followed yearly, intermediate-risk every 6 months and high-risk every 2-3 months.
All scores, except Watanabe post, successfully stratified patients into low-, intermediate- and high-risk groups, with log-rank p-value of 0.001 and Harrell's C ranging from 0.669 to 0.728. Clinical utility of these scores revealed that the highest percentage of patients classified as low risk was 42.5% using the GES, while the lowest was 8.9% using the aMAP. ELRIAH cohort, 25 patients developed HCC with 52% diagnosed at BCLC 0 and A. Tanta cohort, 35 patients developed HCC, with 80% diagnosed at BCLC 0 and A.
Individualized risk stratification using HCC risk scores was associated with improved early-stage detection and receipt of curative treatment.
已开发出多种肝癌风险分层评分系统；然而，尚无一种经过前瞻性验证。主要目的是在一项大型前瞻性研究中，根据欧洲肝脏研究学会（EASL）指南，验证六种肝癌风险评分在接受直接抗病毒药物（DAA）治疗后实现持续病毒学应答（SVR）的F3 - 4期患者中的临床效用。次要目的是探讨个体化风险分层是否能改善对适合根治性治疗的早期肝癌的检测。
这项前瞻性研究包括两个队列：埃及肝脏研究机构与医院（ELRIAH）队列，463例患有晚期肝病（F3和F4）的慢性丙型肝炎患者实现了SVR，根据EASL指南每6个月进行一次随访，使用6种简单的肝癌风险评分；以及坦塔（Tanta）队列，492例可比患者，根据GES评分进行肝癌风险评估，为其量身定制个体化监测间隔，具体如下：低风险患者每年随访一次，中风险患者每6个月随访一次，高风险患者每2 - 3个月随访一次。
除渡边评分外，所有评分均成功将患者分为低、中、高风险组，对数秩检验p值为0.001，Harrell's C值范围为0.669至0.728。这些评分的临床效用显示，使用GES评分时，归类为低风险的患者比例最高，为42.5%；而使用aMAP评分时最低，为8.9%。在ELRIAH队列中，25例患者发生肝癌，其中52%在巴塞罗那临床肝癌（BCLC）0期和A期被诊断出。在坦塔队列中，35例患者发生肝癌，其中80%在BCLC 0期和A期被诊断出。
使用肝癌风险评分进行个体化风险分层与改善早期检测及接受根治性治疗相关。
