Su Tung-Hung, Yang Sheng-Shun, Lee Mei-Hsuan, Kao Wei-Yu, Huang Shang-Chin, Chen Fen-Fang, Poon Francis Sk, Tsai Lung-Wen, Chen Yi-Ting, Lin Che, Wang Weichung, Kim W Ray, Kao Jia-Horng
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Clin Mol Hepatol. 2025 Jan 6. doi: 10.3350/cmh.2024.0822.
BACKGROUND/AIMS: There are no hepatocellular carcinoma (HCC) surveillance recommendations for non-viral chronic liver diseases (CLD), such as metabolic dysfunction associated steatotic liver disease (MASLD). We explored the Steatosis-Associated Fibrosis Estimator (SAFE) score to predict HCC in MASLD and other CLD etiologies.
Patients with various CLDs were included from medical centers in Taiwan. The SAFE score, consisting of age, BMI, diabetes, and laboratory data, was calculated at baseline, and patients were traced for new development of HCC. The predictability of the SAFE score for HCC was analyzed using the sub-distribution hazard model with adjustments for competing risks.
Among 12,963 CLD patients with a median follow-up of 4 years, 258 developed HCC. The SAFE score classifies 1, 3, and 5-year HCC risk regardless of CLD etiologies. High (≥100) and intermediate (0-100) SAFE scores increased 11 and 2 folds HCC risks compared to low (<0) SAFE scores. Combining two lower risk tiers (SAFE < 100), a high SAFE score (≥100) was associated with a 7.5-fold risk of HCC (adjusted sub-distributional hazard ratio [aSHR]: 7.54, 95% confidence interval (CI): 5.38-10.60). A high SAFE score increased the risks of HCC in subgroups of viral hepatitis, non-viral hepatitis (aSHR: 11.10, 95%CI: 3.97-31.30) and MASLD (aSHR: 4.23, 95%CI: 1.43-12.50). A hospital cohort (n=8,103) and a community MASLD cohort (n=120,166) validated the high SAFE score (≥100) for HCC risk prediction.
The SAFE score stratifies high risks for HCC in CLD patients regardless of etiologies and helps to select at-risk candidates for HCC surveillance.
背景/目的：对于非病毒性慢性肝病（CLD），如代谢功能障碍相关脂肪性肝病（MASLD），尚无肝细胞癌（HCC）监测建议。我们探讨了脂肪变性相关纤维化评估（SAFE）评分在预测MASLD及其他CLD病因中的HCC情况。
纳入来自台湾医疗中心的各种CLD患者。SAFE评分由年龄、体重指数、糖尿病和实验室数据组成，在基线时计算，对患者进行HCC新发病例的追踪。使用亚分布风险模型并调整竞争风险来分析SAFE评分对HCC的预测能力。
在12,963例CLD患者中，中位随访4年，258例发生HCC。无论CLD病因如何，SAFE评分均可对1年、3年和5年HCC风险进行分类。与低（<0）SAFE评分相比，高（≥100）和中（0 - 100）SAFE评分使HCC风险分别增加11倍和2倍。合并两个较低风险层级（SAFE < 100）后，高SAFE评分（≥100）与HCC风险增加7.5倍相关（调整后的亚分布风险比[aSHR]：7.54，95%置信区间[CI]：5.38 - 10.60）。高SAFE评分在病毒性肝炎、非病毒性肝炎（aSHR：11.10，95%CI：3.97 - 31.30）和MASLD（aSHR：4.23，95%CI：1.43 - 12.50）亚组中均增加HCC风险。一个医院队列（n = 8,103）和一个社区MASLD队列（n = 120,166）验证了高SAFE评分（≥100）对HCC风险预测的作用。
无论病因如何，SAFE评分可对CLD患者的HCC高风险进行分层，并有助于选择HCC监测的高危患者。
