Clinical-guide risk prediction of hepatocellular carcinoma development in chronic hepatitis C patients after interferon-based therapy

Abstract

Background:Interferon (IFN)-based therapies could eradicate hepatitis C (HCV) and reduce the risk of hepatocellular carcinoma (HCC). However, HCC could still happen after sustained virological response (SVR). We aimed to develop a simple scoring system to predict the risk of HCC development among HCV patients after antiviral therapies.Methods:From 1999 to 2009, 1879 patients with biopsy-proven HCV infection treated with IFN-based therapies were analyzed.Results:Multivariable analysis showed old age (adjusted HR (aHR)=1.73, 95% CI=1.13–2.65 for aged 60–69 and aHR=2.20, 95% CI=1.43–3.37 for aged ⩾70), Male gender (aHR=1.74, 95% CI=1.26–2.41), platelet count <150 × 109/l (HR=1.91, 95% CI=1.27–2.86), α-fetoprotein ⩾20 ng ml−1 (HR=2.23, 95% CI=1.58–3.14), high fibrotic stage (HR=3.32, 95% CI=2.10–5.22), HCV genotype 1b (HR=1.53, 95% CI=1.10–2.14), and non SVR (HR=2.40, 95% CI=1.70–3.38) were independent risk factors for HCC. Regression coefficients were used to build up a risk score and the accuracy was evaluated by using the area under the receiver operating characteristic curve (AUC). Three groups as low-, intermediate-, and high-risk are classified based on the risk scores. One hundred sixty patients (12.78%) in the derivation and 82 patients (13.08%) in the validation cohort developed HCC with AUC of 79.4%, sensitivity of 84.38%, and specificity of 60.66%. In the validation cohort, the 5-year HCC incidence was 1.81%, 12.92%, and 29.95% in low-, intermediate-, and high-risk groups, with hazard ratios 4.49 in intermediate- and 16.14 in high-risk group respectively. The risk reduction of HCC is greatest in patients with SVR, with a 5-year and 10-year risk reduction of 28.91% and 27.99% respectively.Conclusion:The risk scoring system is accurate in predicting HCC development for HCV patients after antiviral therapies.

Risk factors for vertical transmission of hepatitis E virus infection

“…The AUC was very similar in the derivation and validation cohort groups, 0.981 (95% CI=0.952‐1.00) and 0.979 (95% CI=0.948‐1.00), which represents the accuracy of the prediction model. Various score models in other types of hepatitis (B and C) have been developed for predicting the probability of disease and adverse events associated with it …”

Prediction of development of hepatocellular carcinoma using a new scoring system involving virtual touch quantification in patients with chronic liver diseases

“…A number of studies [2][3][4][5][6] have already reported the association between HCC development and age, sex, and AFP level. Although each parameter might be a predictive marker of HCC alone, the new scoring system (VFMAP) established in the present study includes all of these parameters and may therefore more accurately predict the risk of developing HCC.…”

“…Chronic liver disease, including that due to persistent infection with hepatitis B (HBV) and hepatitis C (HCV), is a risk factor for the development of HCC [2]. In addition, several factors such as high age, male sex, high a-fetoprotein (AFP) levels, and heavy drinking have been reported to increase the risk of developing HCC in patients with chronic liver disease [3][4][5].…”

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

“…Among HCV-infected individuals, risk factors for HCC include male sex, genotype 3 infection 11 , co-infection with HBV or HIV, diabetes, obesity, and high level of alcohol consumption. 12 Hispanics with HCV are at a significantly higher risk, whereas African Americans are at a considerably lower risk, of developing cirrhosis and HCC than non-Hispanic whites. HCV viremia of any level is a strong risk factor for HCC compared to no viremia.…”